In hypertensive emergency, what is the target reduction in blood pressure within the first hour?

• A. Reduce by 15% in 2 hours
• B. Reduce by 25% in one hour
• C. Normalize within 24 hours
• D. Reduce diastolic to 100 in 24 hours

Answer: (D)

In a hypertensive emergency the goal is controlled, not rapid normalization of blood pressure. The key concept is to lower mean arterial pressure by about 20–25% within the first hour using IV antihypertensives, which usually translates to bringing the BP toward roughly 160/100 mmHg within the first hour. This staged approach continues over the next several hours, aiming for about 160/100–110 and then gradual normalization over 24–48 hours, while avoiding a precipitous drop that could compromise cerebral, coronary, or renal perfusion. Think of this as a careful, titratable reduction rather than rushing to normal levels.