ASYMPTOMATIC HYPERTENSION Flashcards
MANAGEMENT
GOAL: Differentiate Hypertensive Emergency from Asymptomatic Hypertension
Ask the following questions:
- is there acute end organ dysfunction?
- is the dysfunction attributable to elevated blood pressure?
- is altering the BP necessary to improve the organ dysfunction?
GENERAL APPROACH
- RULE OUT HYPERTENSIVE EMERGENCY
Ask about
CNS: Headache, nausea, vomiting, confusion, visual change, neurologic localizing symptoms
Cardiac: chest pain, shortness of breath, ankle swelling, orthopnea, PND
Renal: polyurea, nocturia, hematuria
- HISTORY FOR ASYMPTOMATIC HYPERTENSIVE PATIENTS
Ask about
Is there a PMHx HTN?
Are they compliant with medications? Has there been a medication change?
Is there a recent trigger (high salt diet, alcohol use, NSAID use, steroids, cold meds)?
Are they pregnant or post partum?
When was the last time they had their blood pressure checked (Is this chronic)?
- PHYSICAL EXAM
Organ focused based on presenting complaint
Always include FUNDI for: papilledema, retinal hemorrhage, exudates
- INVESTIGATIONS
ACEP guidelines suggest no real workup is needed.
Consider screening tests on select patients.
Urine Dip: 80-90% sensitive for renal dysfunciton.
Follow up with Serum Renal Studies if hematuria or proteinuria.
Consider ECG for LVH.
- MANAGEMENT
ACEP Clinical Policy: no need for immediate BP reduction in asymptomatic patients
EMREG Policy: consider beginning anti-hypertensives in BP >180/110 and initiate treatment in BP > 200/130
FIRST LINE:
ACE / ARB or CCB
EXEPTIONS:
CAD - BB
Black patients - Thiazide or CCB
- DISPOSITION
Follow up with FMD within 7 days
Recheck electrolytes within 1 week if started on ACE / ARB
