رجل عمره ٥٥ سنة عنده ارتفاع ضغط معروف، نسي أدويته يومين أثناء السفر. جاء للعيادة وضغطه ١٩٦/١١٨، ويشتكي صداعاً خفيفاً فقط. الفحص العصبي طبيعي، ولا يوجد ألم صدر أو ضيق نفس، والبول والكرياتينين طبيعيان. ما التوقع المناسب؟

A 55-year-old man with known hypertension missed his medicines for two days while travelling. At clinic BP is 196/118 with only a mild headache. Neurological exam is normal, there is no chest pain or breathlessness, and urine and creatinine are normal. What is the appropriate expectation?

1. Lower BP to 120/80 within an hour with sublingual nifedipine
2. Ignore the reading because the headache is mild
3. Restart his oral medicines and lower BP gradually over hours to days
4. ICU admission and immediate IV nitroprusside

Answer: C) Restart his oral medicines and lower BP gradually over hours to days. Severe hypertension without organ damage (urgency) is usually managed by restarting oral drugs and lowering gradually. Rapid lowering risks ischaemia, and sublingual nifedipine is no longer used because it is dangerous.