A 68-year-old man with a history of hypertension and chronic heart failure with reduced ejection fraction (EF 30%) presents to the emergency department with acute dyspnea and orthopnea. His blood pressure is 210/120 mm Hg, heart rate 98 bpm, respiratory rate 28 /min, and oxygen saturation 88% on room air. Physical exam reveals bilateral crackles to mid-lung fields, jugular venous distention, and 2+ pitting edema. Laboratory studies show elevated BNP, and chest radiograph confirms pulmonary edema. He has received intravenous furosemide and a nitroglycerin infusion for preload reduction. According to current guideline recommendations, which additional intravenous antihypertensive agent is most appropriate to initiate to achieve controlled afterload reduction?

A 65-year-old man presents to the emergency department with sudden onset of severe, tearing chest pain radiating to his back. On arrival, his blood pressure is 180/110 mmHg and heart rate is 110 bpm. CT angiography confirms an acute Stanford type A aortic dissection. The immediate hemodynamic goals are to reduce heart rate to < 60 bpm and systolic blood pressure to 100–120 mmHg. As the critical care pharmacist, which of the following is the most appropriate initial pharmacologic intervention to achieve these goals?

A 62-year-old man is admitted to the ICU with acute decompensated heart failure complicated by pulmonary edema. His blood pressure on arrival is 220/125 mmHg. He is dyspneic and requires intravenous antihypertensive therapy to manage this hypertensive emergency. Considering both the urgency and safety of blood pressure reduction in this clinical scenario, which of the following initial blood pressure management strategies is most appropriate?

A 62-year-old man with a history of poorly controlled hypertension is admitted to the ICU for a hypertensive emergency. On arrival his blood pressure is 220/130 mm Hg and heart rate is 95 bpm, and he shows signs of end-organ damage (acute kidney injury and papilledema). A continuous intravenous nicardipine infusion is started at 5 mg/h and titrated by 2.5 mg/h every 5 minutes (max 15 mg/h) to achieve a 20% reduction in mean arterial pressure within the first hour. During this initial titration, which parameter is MOST critical to monitor closely to avoid immediate complications?

A 58-year-old man is admitted to the ICU with a blood pressure of 190/110 mmHg. He is alert, denies chest pain or shortness of breath, and has no neurological deficits. Laboratory tests and imaging show no evidence of acute target–organ damage. He received 200 mg of oral labetalol 2 hours ago, with his blood pressure improving to 170/100 mmHg. Given his stable condition and absence of hypertensive emergency features, what is the most appropriate next step in managing his blood pressure?

A 72-year-old man presented with acute right-sided weakness and aphasia and was diagnosed with acute ischemic stroke. He received intravenous alteplase 3 hours ago. His blood pressure is now 188/108 mmHg. For the next 21 hours post-alteplase, which blood pressure target is most appropriate?

A 68-year-old man with long-standing hypertension presents with sudden-onset severe headache, vomiting, and right-sided weakness. On arrival, his blood pressure is 205/115 mm Hg and he is drowsy but arousable (GCS 13). Noncontrast head CT shows a 3-cm left basal ganglia intracerebral hemorrhage without midline shift, and there is no indication for neurosurgical intervention. In the hyperacute phase of spontaneous intracerebral hemorrhage, which initial intravenous antihypertensive strategy is most appropriate to rapidly—but safely—reduce systolic blood pressure and minimize hematoma expansion?

A 68-year-old man with chronic heart failure presents to the ICU with acute shortness of breath, severe hypertension (BP 190/110 mmHg), and bilateral pulmonary edema on chest X-ray. He is tachypneic and hypoxic on supplemental oxygen. Physical exam reveals elevated jugular venous pressure and bilateral crackles. Labs show elevated BNP and mild renal impairment. The clinical diagnosis is acute decompensated heart failure with pulmonary edema complicated by hypertensive crisis. Which of the following pharmacotherapy plans is MOST appropriate for initial management?

A 28-year-old G1P0 woman at 36 weeks’ gestation is admitted to the ICU with severe headache, visual disturbances, epigastric pain, and sustained blood pressures of 170/115 mmHg. Urine dipstick reveals 3+ proteinuria, platelet count is 95,000/µL, AST 80 U/L, and ALT 90 U/L. Given the diagnosis of preeclampsia with severe features, which initial pharmacologic treatment plan is most appropriate for controlling her blood pressure and preventing seizures?

A 62-year-old man is admitted to the ICU with a hypertensive emergency characterized by a blood pressure of 220/130 mm Hg and acute neurological deficits, including confusion and right-sided weakness. Intravenous antihypertensive therapy is initiated to rapidly lower his blood pressure. Given the need for precise titration of IV medications to avoid hypoperfusion injury, which monitoring modality provides the MOST critical continuous and real‐time assessment to guide blood pressure reduction during the initial phase of treatment?