رجل عمره ٤٩ سنة توقف عن أدوية الضغط من شهر، وصل للطوارئ بصداع شديد وزغللة وتشوش ذهني. الضغط ٢٢٠/١٣٠ في القراءتين، والنبض ٩٢، وفحص قاع العين يظهر وذمة. الأشعة لا تظهر نزيفاً. ما هدف العلاج في الساعة الأولى؟

A 49-year-old man who stopped his antihypertensives a month ago arrives with severe headache, blurred vision and confusion. BP is 220/130 on two readings, HR 92, and fundoscopy shows papilloedema. CT shows no bleed. What is the treatment goal in the first hour?

1. Lower MAP by no more than 25% at first
2. Return BP to 120/80 within an hour
3. No lowering until imaging results are back
4. Give sublingual nifedipine quickly

Answer: A) Lower MAP by no more than 25% at first. Rapid lowering causes cerebral, cardiac and renal ischaemia; aim for about a 25% reduction in the first hour, then gradually.