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PDAT5 CV > 7/11/12 - P&P of HT > Flashcards

7/11/12 - P&P of HT Flashcards

1
Q

Secondary Hypertension Causes

Goal:
Remove causative agent or treat underlying condition

A

Caused by:

  • *Comorbid Conditions**
  • *Renovascular / SLEEP APNEA / 1* Aldosteronism**
  • cushings / pheochromocytoma / thyroid disease / HYPERparathyroidism*

Medications
Amphetamines / Steroids / Decongestants / NSAIDS
Estrogens / Calcineurin inhibitors / Ergot Alkaloids / Erythropoiesis-stimuating agents / Estrogens

  • *Food:**
  • *Alcohol / Licorice / Sodium**
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2
Q

What Determines BP?

(Arterial Blood Pressure)

A
  • *ABP** = CO x PR
  • *Cardiac Output x Peripheral Resistance**

CO = SV x HR

  • *PR determined by:**
  • *Vascular Structure/Function**
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3
Q

What determines CO = Cardiac Output?

A

BP = CO x PR

CO = SV x HR

Stroke Volume x Heart Rate

↑Preload = ↑Na+ Intake / renal retention

Venous Constriction
↑RAAS stimulation
↑SNS

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4
Q

What Determines HEART RATE?

BP = CO x PR

CO = HR x SV

A

ParaSympathetic
Rest / Digest
ACth on heart pacemaker cells –> ↓HR

Sympathetic
Fight/Flight
NE/Epi on pacemaker cells:
–> ↑HR & ↑SV –> vasoconstriction –> ↑PR

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5
Q

What Determines STROKE VOLUME?

BP = CO x PR

CO = HR x SV

A
  • *Intrinsic Control**
  • *HEART RATE** & Contractility
  • *Extrinsic Control**
  • *NE/Epi** on BETA-adrenergic receptors
  • ↑*Force of Contraction–>↑SV
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6
Q

What determines PERIPHERAL RESISTANCE = PR?

A

BP = CO x PR

Vascular Constriction** +/- **Vascular HYPERtrophy
↑RAAS
↑SNS over-activity
genetic changes in cell membranes / endothelial factors

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7
Q

Normal BP

ACC/AHA Guidelines

A

SBP = <120 mmHg

AND

DBP = <80 mmHg

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8
Q

ELEVATED BP

ACC/AHA Guidelines

A

SBP = 120-129 mmHg

AND

DBP = <80 mmHg

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9
Q

Stage 1 HyperTension

ACC/AHA Guidelines

A

SBP = 130-139 mmHg

OR

DBP = 80-89 mmHg

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10
Q

Stage 2 HyperTension

ACC/AHA Guidelines

A

SBP = _>_140 mmHg

OR

DBP = >90 mmHg

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11
Q

SPRINT trial Population
Systolic BP Intevention Trial

A

>50 y/o w/ SBP 130-180
AND
> 1 additional RF for CV disease:
> 75 y/o // Clinical CVD (except stroke) // Subclinical CV disease
ASCVD > 15%

Exclusions:
DM / proteinuria / nursing home residents / symptomatic HF / history of CVA

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12
Q
  • *SPRINT**
  • *Prmary Study outcomes & results**
A

CVD composite - first occurence of:
MI / non-MI Acute Coronary Syndrome/Stroke / HF / Death

  • *INTENSIVE TREATMENT** = 2-3 Meds
  • *BETTER ALL**:
  • *Reducing BP / Primary Outcomes / Mortality / Fraility / Gait**
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13
Q

ACCORD BP Results
Action to Control CV risk in DIABETES BP

A

NO BENEFIT in PRIMARY ENDPOINT
composite of non-fatal MI / stroke / CVD death

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14
Q

ACC/AHA BP Goals for:

Clinical CVD
or
10 yr ASCVD Risk > 10%

A

< 130/80

BP Threshold:
> 130/80

Same for those with these specific comorbidities:
DM / CKD / CHF / PAD / secondary stroke prevention
Stable ischemic Heart Disease

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15
Q

ACC/AHA BP Goals for:

No Clinical CVD
or
10 yr ASCVD Risk < 10%

A

< 130/80

BP Threshold:
> 140/90

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16
Q

ACC/AHA BP Goals for:

Older Person > 65y/o
Community Dwelling

A

< 130 SBP

BP Threshold:
> 130 SBP

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17
Q

Screening for Secondary HTN / Refractory HTN

A

Abrupt Onset

Onset < 30 yo

Exacerbation of previously controlled HTN
TOD disproportionate to degree of HTN

Malignant HTN

NEW Diastolic HTN > 65 yo

unprovoked / excessive HypoKalemia

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18
Q

Diagnosis of HT & New Recommendations

A

> 2-3 properly measured BP readings
@
> 2-3 of visits after initial screening

Home BP monitoring recommended

Daytime average > 130/80
ABPM= Ambulatory BP monitor //HBPM = Home

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19
Q

Diagnosis of MASKED HTN
when not on drug therapy

A

Office BP = 120-129 / < 80
after 3months of lifestyle mod & suspected MASKED HTN

Daytime ABPM or HBPM = <130/80mmhg?

  • *YES = MASKED HTN**
  • -> Lifestyle mods + START ANTI-HT DRUG THERAPY
  • *NO = Normal Hypertension**
  • -> Lifestyle mods + Annual ABPM or HBPM to detect progression
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20
Q

Diagnosis of WHITE COAT HT
when not on drug therapy

A

Office BP > 130/80 but <160/100
after 3months of lifestyle mod & suspected WCHT

Daytime ABPM or HBPM = <130/80mmhg?

  • *YES = White Coat Hypertension**
  • -> Lifestyle mods + Annual ABPM or HBPM to detect progression
  • *NO = Normal Hypertension**
  • -> Continue Lifestyle mods + START ANTI-HT DRUG THERAPY
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21
Q

When to treat HTN with Pharmacologic Therapy?
(ACC/AHA)

A
  • *ABP > 140/90**
  • *Primary prevention = no h/o CVD & ASCVD < 10%**

ABP > 130/80 with:
Secondary Prevention = CLINICAL CVD
Primary Prevention: 10yr ASCVD RISK > 10%
Age / Race / Cholesterol Panel / DM risk / BP meds / STATIN / ASA
Smoking

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22
Q

BP Thresholds & Recommendations
for Treatment + Follow up

ELEVATED BP = 120-129 / <80

A

Promote optimal lifestyle habits
Non-pharmacologic Therapy

Reassess in:
3-6 MONTHS

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23
Q

BP Thresholds & Recommendations
for Treatment + Follow up

Normal BP = <120/80

A

Promote optimal lifestyle habits

Reassess in:
1 YEAR

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24
Q

BP Thresholds & Recommendations
for Treatment + Follow up

Stage 1 HTN = 130-139 / 80-89

WITH:
Clinical ASCVDor10yr ASCVD >10%

A

Promote optimal lifestyle habits
+
BP-LOWERING MEDICATION

Reassess in:
1 MONTH
If BP goal is met –> reassess in 3-6 months
if not –> assess adherence / intensify therapy –> 1 month reassessment

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25
Q

BP Thresholds & Recommendations
for Treatment + Follow up

Stage 1 HTN = 130-139 / 80-89

WITHOUT:
Clinical ASCVD or 10yr ASCVD > 10%

A

Promote optimal lifestyle habits

Reassess in:

  • *3-6 Months**
  • same as Elevated BP*
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26
Q

BP Thresholds & Recommendations
for Treatment + Follow up

Stage 2 HTN** = **> 140/90

A

Promote optimal lifestyle habits
+
BP-LOWERING MEDS

Reassess in:
1 YEAR
If BP goal is met –> reassess in 3-6 months
if not –> assess adherence / intensify therapy –> 1 month reassessment

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27
Q

HTN in Older Adults > 65y/o

A

Linear increase in Systolic & Diastolic BP until ~50-60y/o

SBP –> continues to RISE

DBP –> gradually trends down

HYVET & SPRINT:
displayed BENEFIT in elderly, only includes COMMUNITY DWELLING

Monitor for:

  • *Orthostatic Hypotension**
  • *caution for Frequent falls / Cognitive imparment / comorbidities**
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28
Q

Best Proven Nonpharmacological Intervention
for the
Prevention/Treatment of Hypertension

A

Weight Loss

Heat-Healthy Diet
DASH / mediterranian

↓Na Intake & ↓Alcohol Intake

↑K+ Intake, as long as no CI’s

  • ↑*Exercise
  • *150 min/wk moderate exercise** // 30 min 5x/wk
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29
Q

Which HTN Drug?

Blockade of sodium reabsorption @distal tubule causing initial volume loss mostly in 1st week

long term CO & volume return closer to baselline while SVR decreases
2/2 Vasodilatory effects

ADR:
Electrolyte abnormalities: hypo-Na/Mg/K – HYPER-Calemia
frequent Urination / GOUT / dehydration / glucose intolerance

A
  • *THIAZIDE_ _DIURETICS**
  • *Hydrochlorothiazide, chlorthalidone, indapamide, metolazone**

1st Line Drug

Low dose chlorathalidone (12.5-25mg) preferred thiazide
longer t1/2 & proven CVD reduction

Limitations:
Reduced efficacy with comorbid renal disease

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30
Q

Which HTN Drug?

BLOCK conversion of AT1 –> AT2 = vasodilation / ↓aldosterone

↓Bradykinin metabolism –> ↑Bradykinin –> Vasodilation

ADR:
HYPERKalemia / COUGH
angioedema / nephrotoxicity / pancreatitis

A
  • *ACE INHIBITORS**
  • *-prils**

1st Line Drug

ACC/AHA:
CKD Stage 1 or 2 AND albumin:creatinine ratio > 300mg/g or 30-299mg/g creatinine
Or
CKD Stage 3 or 4 // HFrEF // CAD

Limitations:
COUGH –> ARB

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31
Q

Which HTN Drug?

Blockade of sodium reabsorption @distal tubule causing initial volume loss mostly in 1st week

long term CO & volume return closer to baselline while SVR decreases
2/2 Vasodilatory effects

ADR:
Electrolyte abnormalities: hypo-Na/Mg/K – HYPER-Calemia
frequent Urination / GOUT / dehydration / glucose intolerance

A
  • *THIAZIDE_ _DIURETICS**
  • *Hydrochlorothiazide, chlorthalidone, indapamide, metolazone**

1st Line Drug

Low dose chlorathalidone (12.5-25mg) preferred thiazide
longer t1/2 & proven CVD reduction

Limitations:
Reduced efficacy with comorbid renal disease

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32
Q

Which HTN Drug?

Blocks actions of AT2
Vasodilation, ↓aldosterone synthesis

ADR:
HYPERKalemia, Nephrotoxicity
angioedema (very rare)

A
  • *ARBs**
  • *-sartans**

1st Line Drug
typically for ACE intolerance

ACC/AHA:
CKD Stage 1 or 2 AND albumin:creatinine ratio > 300mg/g or 30-299mg/g creatinine
Or
CKD Stage 3 or 4 // HFrEF // CAD

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33
Q

Which HTN Drug?

Vasodilation of vascular smooth muscle via calcium antagonism

ADR:
Headache / lightheadedness / flushing
dose-dependent peripheral edema, gingival hyperplasia
–> decrease dose or switch agent and/or add RAAS-blocking (ACE/ARB)

A
  • *Calcium Channel Blockers - DHP**
  • *Amlodipine, Nifedipine, Felodipine, Nicardipine**

1st Line Drug

Biggest role is:
those w/o “compelling indications” & add-on therapy

34
Q

Which HTN Drug?

↓CO via ↓HR & ↓Contractility
from inhibition of calcium ion from entering voltage sensitive areas of myocardium during depolarization

ADR:

  • *Bradycardia / Heart block**
  • *HF Exacerbation (↓CO)**, dose dependent CONSTIPATION
A
  • *NON-DHP - Calcium Channel Blockers**
  • *Diltiazem & Verapamil**
  • *ADD-ON THERAPY**
  • can be 1st line ACC/AHA*

Biggest role is
Patients w/ Comorbid AFIB
Patients w/ CAD who CANNOT tolerate Beta-Blocker Therapy

Limitations:
CI w/ Beta-blockers (additive) / HFrEF / 2nd-3rd Heart Block
PK drug interactions: CYP3a4 substrate/inhibitor

35
Q

Which HTN Drug?

Blockade of B1-receptors –> ↓CO via ↓HR & ↓SV
Specifically:
NONselective B1 & B2 adrenergic blocker

ADR:
Bradycardia / heart block / Bronchoconstriction
lethargy / sex dysfunx / reynaud’s phenomenon

A
  • *NON-Selective BETA BLOCKERs**
  • *PROPRANOLOL**

2nd line / add-on Agent

Critical role in:
CAD (ischemic - MI) // HFrEF
rate control

36
Q

Which HTN Drug?

  • Blockade* of B1-receptors –> ↓CO via ↓HR & ↓SV
  • *CARDIOSELECTIVE**

ADR:
Bradycardia / heart block / Bronchoconstriction
lethargy / sex dysfunx / reynaud’s phenomenon

A
  • *Cardioselective BETA BLOCKERs**
  • *Atenolol, Bisoprolol, Metoprolol, Nebivolol**

2nd line / add-on Agent

Critical role in:
CAD (ischemic - MI) // HFrEF
rate control

37
Q

Which HTN Drug?

Blockade of B1-receptors –> ↓CO via ↓HR & ↓SV
Specifically:
MIXED - nonselective Alpha < Beta adrenergic blockade

ADR:
Bradycardia / heart block / Bronchoconstriction
lethargy / sex dysfunx / reynaud’s phenomenon

A
  • *Mixed BETA BLOCKERs**
  • *Carvedilol / Labetalol**

2nd line / add-on Agent

Critical role in:
CAD (ischemic - MI) // HFrEF
rate control

38
Q

Which HTN Drug?

Inhibits Symphathetically mediated arterial vasoconstriction
via blockade of alpha-1 receptors on vascular smooth muscle

ADR:
First dose - orthosttic effect / dizziness / fatigue / HA

A
  • *ALPHA-BLOCKERS**
  • *Doxazosin, Terazosin, Prazosin**
  • Rarely used, ADD-on only*
  • ALLHAT trial –> inferiority to other drugs in CV endpoints*

BPH d/t Relaxation of Bladder neck
IF NOT HIGH CV RISK

39
Q

Which HTN Drug?

Production of false SNS Neurotransmitters

ADR:
edema / dizziness / impotence / arrythmia

A
  • *Centrally Acting Drugs**
  • *METHYLDOPA**

RARELY USED

PREGNANCY

40
Q

Which HTN Drug?

Binds to central pre-synaptic Alpha-2 adrenergic receptors
↓Sympathetic outflow from CNS

ADR:
Bradycardia / Drowsiness
Rebound HTN w/ abrupt DC –> Taper off

A
  • *Centrally Acting Alpha-2 Agonist**
  • *CLONIDINE**

Add-on Therapy
only later line 2/2 CNS SE

Once-Weekly transdermal dosage for non-adherent pts

41
Q

Which HTN Drug?

Direct Vasodilation of Arterioles

ADR:

  • *edema , drug-induced lupus/vasculitis**
  • *reflex tachycardia**
A
  • *Vasodilator**
  • *HYDRALAZINE**

Add-on Therapy - 3rd/4th line

IV dosage –> QUICK onset & SHORT duration

Useful in combination with:
Nitrates for Pts w/ HFrEF - esp AA pts

42
Q

Which HTN Drug?

Vasodilation via smooth muscle relaxation
possibly mediated by cAMP

ADR:
Hirsutism, edema, T-wave Changes
Reflex Tachycardia (always used w/ BB), pericadial effusions

A
  • *Vasodilator**
  • *MINOXIDIL**

limited Add-on Therapy - 3rd/4th line

Many ADR’s & limited efficacy (organ outcomes)

Significant BP reduction

43
Q

When to use this HTN drug?

Loop Diuretics
bumetanide / furosemide / torsemide

A

Primarily used as:

  • *DIURETIC**
    when: CrCl <30 or CKD stage 4/5

Similar e- disturbances to thiazides, except:

  • *Calcium Depleting**
  • less likely to cause hypoNatremia*
44
Q

When to use this HTN drug?

Potassium Sparing Diuretics
Amiloride / Triamterene

A

Primarily used as:

  • *Thiazide + K-sparing combo_ if _hypoKalemic on thiazide** -
  • BUT caution with GFR <45mL/min
45
Q

When to use this HTN drug?

Anti-Aldosterone Antagonist
Eplerenone / Spironolactone

A

Primarily used for
Primary Aldosteronism
&
Resistant HYPERTension

  • *Eplerenone = BID dosing**
  • *Spironolactone = Gynecomastia**

HyperKalemia –> caution with K+ & CKD

46
Q

Choosing a BETA BLOCKER:

HFrEF

A

Carvedilol
Mixed A/B

Metoprolol & Bisoprolol
cardioselective –> B1

Proven Mortality Benefit

47
Q

Choosing a BETA BLOCKER:

Asthma / COPD

A

B-1 Selective Agent:
Atenolol / Metoprolol

Avoid Mixed / nonselective

48
Q

Choosing a BETA BLOCKER:

BPH

A

Consider Alpha-Blockade
Carvedilol / Labetalol

49
Q

Choosing a BETA BLOCKER:​

Type 2 DM

A

CARVEDILOL > Metoprolol

Associated with lower A1c & microalbuminia

50
Q

Choosing a BETA BLOCKER:

Migraines

A

Consider Lipid Solubility = Crosses BBB

Propanolol / Carvedilol

51
Q
  • *Exceptions to the rule:
  • Avoid Drugs with SIMILAR TARGETS on BP control***
  • *Ace + Arb + Renin Inhibitor**
  • NOT RECOMMENDED*
A

Diuretics

Non-DHP + DHP CCB

52
Q

Choosing Initial Antihypertensive Drug Therapy

Non-Black Population
&
W/ CKD

A

Thiazide / ACE / ARB / CCB

ACE/ARB preferred
for CKD

53
Q

Choosing Initial Antihypertensive Drug Therapy

  • *Black Population w/o HF/CKD**
  • including those with DM*
A
  • *THIAZIDES_ / _CCBs**
  • preferred over ACE/ARB*
54
Q

Choosing Initial Antihypertensive Drug Therapy

Black Population with
CKD+/-Proteinuria

A
  • *CKD 1/2** + Proteinuria OR CKD 3/4:
  • *ACE/ARB**
55
Q

Choosing Initial Antihypertensive Drug Therapy

Black Population with
HFrEF&CHD s/p MI

A

Beta Blockers** & **ACEI/ARB

56
Q

What antihypertensive for:
PREGNANT?

A

MethylDopa
Centrally Acting a2-agonist

Nifedipine
1,4-DHP CCB

Labetalol
Mixed a/b - blockers

57
Q

What antihypertensive for:

HFrEF

A

Beta Blocker

ACE/ARB

Anti-Aldosterone

58
Q

What antihypertensive for:

MI

A

Beta Blocker / ACE

59
Q

What antihypertensive for:

CKD Stage 1 or 2
AND
urinary albumin:creatinine ratio > 300mg/g or 30-299mg/g creatinine

OR
CKD Stage 3 or 4

A

ACE/ARB

60
Q

What AntiHypertensive for:

DIABETES

A

ACE / ARB

CCB - DIURETICS

if albuminuria –> ACE/ARB

61
Q

What AntiHypertensive for:

AFIB / Flutter rate Control

A

NON-DHP CCB
Verapamil = PAA / Diltiazem = BTZ

Beta Blocker
lol’s

62
Q

When to avoid this antihypertensive due to contraindications:

THIAZIDES

A

GOUT

63
Q

When to avoid this antihypertensive due to contraindications:

CCBs / Vasodilators

A
  • *Venous Insufficiency**
  • avoid CCB & vasodilators*

Bradycardia / Heart Block
BB’s & Non-DHP CCB

  • *HFrEF**
  • caution with Non-DHP CCB*
64
Q

When to avoid this antihypertensive due to contraindications:

Beta Blockers

A

ASTHMA / COPD
especialy NON-cardioselective like propranolol

Bradycardia / Heart Block
BB + Non-DHP CCB = negative chronotropes

65
Q

When to avoid this antihypertensive due to contraindications:

ACE/ARB

A

HYPERKalemia
ACE/ARB + Spironolactone

Pregnancy
ACE/ARB + Renin Inhibitors -skirin

66
Q

Results of ALLHAT trail

HTN + 1 Additional major CV risk factor

Primary Endpoint:
Fatal CHD or nonfatal MI

A

In comparison to Thiazide:

Amlodipine (CCB) / Lisinopril (ACE) = Very Similar

  • except for:*
  • *DOXAZOSIN = Beta Blocker**
  • INFERIOR TO OTHER THERAPIES*

But is still recommeneded for initial therapy if patient has:
CAD/MI or CHF
1st line for secondary prevention of MI & ↓Mortality w/ HFrEF

67
Q

When do patients require 2+ HTN Drugs?

A

Most patients require 2+ to reach goal BP

Especially when:
BP > 20/10 mmHG (>160)
over goal

Stage 2 HTN –> 2x 1st line drugs

68
Q

Complementary Combination Therapies

A

ACE/ARB** + **Thiazide
for maintaining K+ Balance
Diuretics can trigger RAAS –> ACE can blunt this

  • *ACE/ARB_ + _DHP-CCB**
  • lessen peripheral edema* from CCB

Vasodilator + Beta-Blocker + Diuretic
BB blunting of reflex tachycardia
Diuretic for Na + H2O retention

69
Q

Resistant HTN

Definition & Risk Factors

A

Not at goal on 3 BP Meds (including diuretic)
OR
Controlled on > 4 BP meds

Risk Factors:
Older Age >65
Obesity
Black
DM

70
Q

Non-Pharmacologic Treatment
Resistant HTN

A

Assess/Improve ADHERENCE

Consider/Correct Secondary Causes:
1* Aldosteronism / OSA / Renal Artery Stenosis

Target other modifiable caracteristics:
Obesity / Inactivity / Salt / low Fiber

  • *D/C Meds that can cause HTN:**
  • *NSAIDS / DECONGESTANTS / AMPHETAMINES**
71
Q

Medication Management
Resistant HTN Treatment

A

D/C or minimize: NSAIDS / Decongestants / Amphetamines

  • *Maximize DIURETIC**
  • *CHLORTHALIDONE** (preferred diuretic) > HCTZ

+ADD+ Anti-Aldosterone Diuretic
PATHWAY RCT, Spironolactone > a/b blockers

  • *+ADD+ agents w/ different MoA**
  • *Loop Diuretics** w/ CKD and/or those on potent vasodilators (minoxidil)
72
Q

Major Causes of
SECONDARY HTN
&
Treatments

A

SLEEP APNEA
Spironolactone / CPAP / surgical correction

Aldosteronism
Spironolactone

RenoVascular Disease (Stenosis)
Vascular surgery, RAAS blockade w/ diuretic

HyperThyroid

Renal Parenchymal Disease

73
Q

#1 Cause of Secondary Hypertension

&

TREATMENT

A

SLEEP APNEA

SPIRONOLACTONE

CPAP

Surgical Correction

74
Q

Monitoring for BP therapy

A

MONTHLY follow-up until BP is controlled
Evaluate BP / Adherence / ADRs / Lifestyle Mods

  • *Lab Assessment:**
  • *dosing RAAS AGENT: BMP** within 2-4 weeks
  • *dosing DIURETIC: BMP** within 1-2 weeks after changes –> q6-12m
75
Q

HyperTensive Crisis

Definition & Target Organs

A
  • *Acute** + Accelerated HTN that threatens or damages “end organs”
  • *Brain** –> stroke/hemorrhage/EC(encephalopathy)
  • *Heart**–> MI/aortic dissection / ventricular dysfxn
  • *Kidneys** –> acute renal failure
  • *Eyes** –> retinal hemorrhage

URGENCY vs EMERGENCY

76
Q

HyperTensive Crisis​

URGENCY vs EMERGENCY

A

URGENCY
Severe elevations in BP = >180/120 mmHg

Emergency
Severe Elevations in BP
+
SIGNS OF END ORGAN DMG

77
Q

Treatment for

Hypertensive URGENCY
severe BP elevation:
>180/120 mmHg

A
  • aggressive treatment does MORE HARM vs GOOD*
  • *Abrupt “normalizing”** –> organ damage
  • *Organs can be ACCLIMATED to highBP**

Management:
Investigate S/Sx of end-organ damage
&
reduce BP** **–> OVER DAYS- WEEKS
primarily with PO meds

78
Q

Treatment for

Hypertensive EMERGENCY
severe BP elevation:
>180/120 mmHg
&
SIGNS OF END-ORGAN DMG

_WITHOUT compelling conditions_:
Aortic Dissection / Severe Preclamsia / Pheochromocytoma Crisis

A

Goal:
↓BP by 25% in 1st hour
then:
↓BP to 160/100-110 over the next 2-6 hours
then
Normalize over next 24-48 hours

Goal is to NOT normalize BP immediately!
exceptions = Aortic Dissection & Severe (pre)eclampsia or Pheochromocytoma criss

79
Q

Treatment for

Hypertensive EMERGENCY** + **AORTIC DISSECTION
severe BP elevation:
>180/120 mmHg
&
SIGNS OF END-ORGAN DMG

A

Aortic Dissection = Exception

Reduce SBP < 120 during 1st hour

80
Q

Treatment for

Hypertensive EMERGENCY + (Pre)eclamsia or Pheochromocytoma
severe BP elevation:
>180/120 mmHg
&
SIGNS OF END-ORGAN DMG

A

Exception

Reduce SBP < 140 during 1st hour

PDAT5 CV (30 decks)

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