Acute Hypertensive Crisis Flashcards
Hypertensive Emergency vs Urgency
Urgency
-SBP > 180
-DBP > 120
Emergency
-SBP > 180
-DBP > 120
-Acute organ injury (AKI, MI, stroke, encephalopathy)
Common Presenting Subjective Symptoms
-SOB
-Pain
-HA
-Altered mental status
-Focal neurological deficit
Goals of Therapy
- Resolve clinical symptoms
- Prevent end organ damage or worsening of organ damage
- Achieve specified BP goals
Hypertensive Urgency TX
- Reinstitute/intensify ORAL ant-HTN therapy and arrange follow up
- Optional: PRN dosing of short acting meds
Short-acting Oral Blood Pressure Medications for Optional Urgency TX
Clonidine
-fast, in clinic but brady/sedation
Captopril
-fast, titrate but AKI/hyperkalemia
Labetalol
-vasodilating, but brady/long half life
Minoxidil
-vasodilator, but edema/reflex tachy
MLCC
Hypertensive Emergency TX
- Admit to ICU
- Aortic dis/preclampsia/pheo?
*YES = decrease to SBP < 140 in first hour or < 120 if aortic dis
*NO = decrease by max 25% in first hour then to 160/100-110 over 2-6 hours then normal in 24-48 hours
Nitroglycerin (IV)
For emergency (HET)
AE: Headache, Tachyphylaxis
Nitroprusside (IV)
For emergency (CEC)
AE: Cyanide toxicity, Coronary steal
Hydralazine (IV, PO)
For emergency
AE: Tachycardia
Enalaprilat
For emergency
AE: AKI
Fenoldopam
For emergency (PIE)
AE: Increased intraocular pressure
CCBs for Emergency
DHPs preferred because of vascular selectivity
Nicardipine: reflex tachy/HA (most common)
Clevidipine: soy/egg allergies, ↑ triglycerides
Diltiazem, Verapamil (not really used)
Intravenous Beta Blockers (EM)
Esmolol, Labetalol, Metoprolol
-all decrease HR
Preferred Agents in EM
LABETALOL preferred IV push unless
*acute HR, bradycardia, or possibly asthma/COPD -BACH
NICARDIPINE preferred IV continuous
Acute Myocardial Infarction
nitroglycerin; esmolol, labetalol, metoprolol (M for MELN)
NOT nitroprusside