Defined as elevated BP (usually systolic BP >210 mmHg and diastolic BP >130 mmHg) with rapid decompensation of vital organ function.
If the clinical suspicion is high, treatment should be initiated immediately without waiting for further tests.
BP must be lowered over minutes to hours with parenteral medications in an intensive care setting. Oral medications should be given shortly thereafter to permit weaning from parenteral agents.
The initial goal of therapy is to reduce mean arterial BP by no more than 25% (within minutes to 1 hour), then, if stable, to 160 mmHg systolic and 100-110 mmHg diastolic within the next 2 to 6 hours. Exceptions to this general rule are patients with intracranial pathology and patients with aortic dissection. Excessive falls in pressure that may precipitate renal, cerebral, or coronary ischemia should be avoided.