Symptomatic severe hypertension, SBP above 180 mmHg and/or DBP above 110 mmHg, WITHOUT evidence of target organ damage such as pulmonary oedema, cardiac ischaemia, neurological deficit or acute renal failure.

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

Pharmacological

Goal: lower the DBP to about 100 mmHg slowly over 48–72 hours, preferably with two or more oral agents. Aim for BP below 140/90 mmHg within 3 months; if not controlled after 3 months, refer to the regional referral hospital.

• B: Amlodipine 5–10 mg once daily OR A: nifedipine retard 20 mg twice daily,

• AND B: captopril 25 mg three times daily OR B: losartan 50–100 mg once daily,

• OR B: atenolol 50–100 mg once daily if there is no contraindication and a compelling indication,

• AND a thiazide: bendroflumethiazide 2.5–5 mg once daily OR hydrochlorothiazide 12.5–50 mg once daily OR chlorthalidone 12.5–25 mg once daily.

• Preferred fixed-dose combination: losartan 50 mg + hydrochlorothiazide 12.5 mg once daily.

• Loop diuretic (furosemide) helps in renal insufficiency and pulmonary oedema.