79
Identified in OPT setting
Severe hypertension
Identified in ED
Close follow-up in the
OPT setting in 4 weeks
1
Reduce SBP by 25% in the first
house and to <160/100–110
over the next 6 hours and to
normal in the next 24–48 hours
Avoid parenteral BP lowering
therapy or intensified oral
therapy in the acute setting
3: Harm
* Defined as acute heart failure/pulmonary edema, neurologic disorders (posterior reversible
encephalopathy syndrome, encephalopathy, retinal hemorrhage, papilledema, intracranial
hemorrhage, acute ischemic stroke), acute decompensated heart failure, acute coronary
syndrome, acute kidney injury, acute aortic syndrome (penetrating aortic ulcer, aortic dissection).
DBP indicates diastolic blood pressure; ED, emergency department; ICU, intensive care unit;
INP, inpatient; OPT, outpatient; and SBP, systolic blood pressure.
For reinstitution, modification or intensification of medical therapy, refer to sections 5.2.2.
through 5.2.4.
Modified with permission from Whelton et al. Copyright © 2018 American College of
Cardiology Foundation and American Heart Association, Inc.
No need to refer to ED.
Reinstitute and intensify or
modify medical therapy in the
OPT setting
Evaluate INP vs OPT
treatment depending on
indication(s) other than BP
alone
×
AVOID
