The nurse managing hypertensive emergency must independently select the appropriate treatment target and titrate IV antihypertensives based on the specific end-organ damage present. Treatment targets vary by clinical scenario: General hypertensive emergency: reduce MAP by no more than 25% in first hour, then toward 160/100 over 2-6 hours, then gradually to normal over 24-48 hours. Acute aortic dissection: EXCEPTION to gradual reduction; SBP target below 120 mmHg AND heart rate below 60 bpm within 20 minutes (IV esmolol + nicardipine or nitroprusside). Acute ischemic stroke: if thrombolysis candidate, reduce BP to below 185/110 BEFORE tPA, then below 180/105 for 24 hours after; if NOT a thrombolysis candidate, treat only if BP above 220/120. Intracranial hemorrhage: SBP target 140 mmHg (INTERACT2 trial). Pre-eclampsia/eclampsia: IV labetalol or hydralazine; magnesium sulfate for seizure prevention; delivery is definitive treatment. The nurse titrates continuous infusions using arterial line monitoring when available, assesses neurological status using NIH Stroke Scale or Glasgow Coma Scale, monitors cardiac rhythm, and manages multi-organ assessment.