Define hypertensive crisis and its management priority.

• A. SBP >140 or DBP >90; oral meds.
• B. SBP >180 or DBP >120 with target organ damage risk; requires IV antihypertensives and close monitoring.
• C. SBP <90 with mental status change; requires fluids.
• D. DBP >100 with headache; observation only.

Answer: (B)

Hypertensive crisis is a situation where blood pressure is extremely high and there is real risk of, or actual, damage to organs. The priority in managing this is to drop blood pressure quickly but safely using intravenous antihypertensive medications in a setting where the patient can be closely monitored, because the damage to organs can progress rapidly if untreated.

The defining feature for urgent, urgent/severe management is a systolic pressure around 180 mmHg or higher or a diastolic pressure around 120 mmHg or higher, especially when there is evidence of target-organ damage (such as altered mental status, stroke symptoms, chest pain or signs of heart failure, kidney injury, or retinal changes). In this scenario, IV therapy allows rapid, titratable control of blood pressure with continuous monitoring to avoid reducing perfusion too quickly, which is crucial.

Other options imply either lower pressure thresholds, use of oral meds alone, hypotension, or nonurgent observation—scenarios that do not reflect the need for immediate, monitored intervention to prevent organ injury.