Table 5.

BIHS position: Management of hypertensive encephalopathy.

Hypertensive state	Hypertensive encephalopathy
Speed of BP reduction and BP targets	Balance the risk of increasing cerebral oedema and ischaemia against the risk of rapid lowering of BP below cerebral autoregulation and subsequent infarction.
	1. Most patients will need invasive BP monitoring and IV therapy especially if BP elevated (above 160/100 mmHg).
	2. If BP elevated, reduce MAP by no more than 20–25% over several hours and/or reduce DBP to between 110 and 100 mmHg within 24 h.
	3. Subsequently transition to oral medications to reach and maintain BP within days to weeks.
Medications	Drug of choice: Initially IV labetalol (managed in a high dependency unit) monitoring with neuro-observations.
	If patient has asthma, calcium channel blockers can be used such as IV nicardipine.