Therapy

• If there is evidence of end-organ damage, aim to reduce the blood pressure immediately Otherwise aim for a gradual reduction over 24 hours. ^d
• Avoid reducing the blood pressure too rapidly  ^c.  Aim for a reduction to < 120 mmHg or a fall > 20 mmHg ^{d .}  Repeat blood pressure readings frequently. ^d

Try any of

• nifedipine 5 mg orally chewed then swallowed ^d  as capsules or sustained release ^d 
• nicardipine 30 mg orally ^a  
• enalapril 0.625 mg orally ^c  or captopril 25 mg sublingually ^a  (especially in cases of scleroderma ^b )
• labetalol orally ^d  (especially in phaechromocytoma crises)
• oral clonidine ^a  

The indications for parenteral therapy (usually with short-acting and titratable agents )are unclear. It is commonly used for patients with severe end-organ damage. ^d Seek assistance if you think this is indicated. ^d

Renovascular hypertension

Consider renal angioplasty ^a or medication.