BP > 180/120 with end-organ damage. Goal is controlled reduction — NOT rapid normalization.
Steps by Cert Level
AEMT: BP measurement bilateral arms. 12-lead ECG. IV access. Calm environment — reduce stimulation. Do NOT rapidly lower BP — target 10–15% reduction over hours.
PARAMEDIC: Identify end-organ damage: neurologic (encephalopathy, stroke), cardiac (acute MI, dissection), renal, ophthalmologic (papilledema). Aortic dissection: HR and BP control — Labetalol 20mg IV slow push. Hypertensive encephalopathy: Labetalol 20mg IV. Seizure: Benzodiazepine. If STEMI + hypertension: NTG drip per medical control.