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High blood pressure

NEWS calls

Treat the patient, not the number: look for target organ damage.

Raised BP on the ward rarely needs rapid IV lowering, and lowering it too fast can cause harm.

Act now

  1. 1

    Treat the trigger: analgesia, bladder scan, restart missed regular medication.

Assess

  • Repeat manually with the right cuff size, after rest; check both arms if dissection is possible.
  • Common ward causes: pain, full bladder, anxiety, missed antihypertensives, alcohol withdrawal, drugs (steroids, NSAIDs, decongestants).
  • Symptoms of organ damage: severe headache, visual change, confusion, seizures, chest or back pain, breathlessness, low urine output.
  • Pregnant or up to 6 weeks postpartum: think pre-eclampsia.

Investigations

  • Fundoscopy (papilloedema, retinal haemorrhage), urine dip for protein and blood, U&E, ECG; troponin if chest pain; CT head if neurological signs.

Manage

  • 180/120 mmHg or above with no organ damage: no emergency IV treatment. Recheck, review oral therapy with the team.
  • 180/120 mmHg or above with papilloedema, retinal haemorrhage or life-threatening symptoms: same-day senior or specialist review.
  • Hypertensive emergency (encephalopathy, AKI, pulmonary oedema, ACS, dissection, eclampsia): HDU and IV treatment, generally lowering by no more than 20–25% in the first hour.
  • Acute stroke has its own targets — see the Acute stroke topic.
  • Do not use sublingual nifedipine.

Escalate when

  • Any target organ damage, suspected dissection, or pregnancy-related hypertension: senior now (obstetrics for pregnancy).

Doses and prescribing

Restart the patient's usual antihypertensives if they were missed.

IV labetalol or GTN only in a monitored setting under the local hypertensive emergency protocol.

Check the BNF and your local formulary before prescribing.

Written to current guidance (NICE NG136, NG128) · sources checked 14 Nov 2026. We watch NICE for updates weekly.

Sources (3)

Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026

Calculators for this

For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.