18. Hypertensive emergencies Flashcards
1
Q
What is a hypertensive emergency?
A
A severe state of hypertension where we can see signs of organ failure due to the high BP
2
Q
What are examples of hypertensive emergency?
A
- AHF
- Aneurysm rupture
- Aortic dissection
- Stroke
- ACS (MI)
- AKI
- Blindness due to papillary edema
- Malignant hypertension
- Eclampsia/preeclampsia of pregnancy
- Adrenergic crisis
3
Q
What is malignant hypertension?
A
- Abrupt BP increase in patient with underlying HTN or in a previously normotensive person.
- The absolute level of HTN is not as important as the rate of the rise of HTN
- Associated with necrotizing vasculitis, arteriolar thrombi, fibrin deposition in arteriolar walls
- Fibrinoid necrosis in arterioles of kidney, brain, retina and other organs
Diagnosis:
- Progressive retinopathy
- Deteriorating renal function with proteinuria
- Microangiopathic hemolytic anemia
- Encephalopathy
4
Q
How do you decrease the BP in hypertensive emergency?
A
- In case of HF: decrease SBP and HR fast down to 100mmHg
- In other cases: decrease BP by 20-30% within a period of 2h
We mainly use IV treatment:
- Sodium nitroprusside
- Nitroglycerin
- Alpha and beta blockers
- Urapidyl
5
Q
What is a hypertensive urgency?
A
A state where there is a possibility for organ failure du to high BP (usually SBP of these people is 180 mmHg)
6
Q
What should be done in a hypertensive urgency?
A
Decrease the BP by the end of the day.
Drugs used:
- Captopril
- Nitroglycerin
- Ca2+-channel blockers (amlodipin)
