This patient presents with hypertensive emergency characterized by severely elevated BP, neurological symptoms, and papilledema indicating end-organ damage. The first-line treatment is IV antihypertensives like labetalol or nicardipine to gradually reduce BP by no more than 25% within the first hour, preventing cerebral hypoperfusion. IV agents allow rapid, controlled BP lowering in the hospital setting. Oral agents and sublingual nifedipine are contraindicated due to unpredictable effects and risk of ischemia. Mannitol is used for raised intracranial pressure but is not primary treatment in hypertensive emergencies without clear cerebral edema.

Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.