What should be avoided in terms of blood pressure reduction in hypertensive emergencies and urgencies?

In hypertensive emergencies and urgencies, a decrease of more than 25% within the first hour should be avoided because it can lead to inadequate cerebral perfusion and potentially result in ischemic complications, especially in patients who have chronic hypertension. The general guideline for management emphasizes a cautious approach to blood pressure reduction. Rapidly lowering blood pressure can be counterproductive and may precipitate adverse outcomes, such as stroke or myocardial ischemia.

The goal is to reduce blood pressure by no more than 25% in the first hour, allowing the body to adjust safely. This careful titration helps ensure that vital organs continue to receive adequate blood flow while still managing the hypertensive state effectively. The management strategy aims to reach a target blood pressure gradually rather than in a rushed manner, which could adversely affect the patient's condition.