Symptomatic severe hypertension SBP 180mmHg and/or DBP >110 mmHg with evidence of Target Organ Damage or grade III/IV Retinopathy with no immediate life–threatening neurological or cardiac complication such seen in emergencies

Note: All patients with hypertensive urgency should be treated in hospital

Pharmacological

The goal is to lower DBP to 100mmHg slowly over 48–72 hours. This can be achieved with two or more oral agents preferably

Long acting calcium channel blocker

AND

ACE inhibitor (use in low dosage initially)

OR

Beta -blocker if not contraindicated with compelling indication

AND/OR

Diuretic – Thiazide or Loop diuretics (i.e. furosemide)- beneficial in renal insufficient pulmonary oedema and potentiate above other classes