Which patient is having a hypertensive emergency?

• A. A patient with a blood pressure of 120/80 mm Hg, headache, and blurred vision
• B. A patient with a blood pressure of 180/120 mm Hg with no symptoms
• C. A patient with a blood pressure of 165/95 mm Hg with no symptoms
• D. A patient with a blood pressure of 190/150 mm Hg, headache, and blurred vision

Answer: (D)

Hypertensive emergency occurs when the blood pressure is very high and there is acute evidence of target-organ damage. The patient with a blood pressure of 190/150 mm Hg and accompanying headache and blurred vision shows end-organ involvement (brain/retina) from an abrupt BP rise, which defines an emergency. This situation requires rapid blood pressure reduction with intravenous therapy and close monitoring.

The other scenarios don’t show both the severe pressure and organ damage. A blood pressure of 180/120 mm Hg with no symptoms is hypertensive urgency, not an emergency, so it’s typically treated with oral medications and careful follow-up. A BP of 165/95 mm Hg with no symptoms isn’t in the emergency range. A normal pressure with headache and blurred vision is unlikely due to hypertensive emergency, since the BP isn’t elevated enough to cause acute organ damage.