CHAPTER 57 SYSTEMIC HYPERTENSION Flashcards
Categories of Blood pressure
-normal
-elevated
-Stage 1 HPN
-Stage 2 HPN
Normal: <120/<80
Elevated: 120-129/<80
Stage 1 HPN: SBP 130-139 or DBP 80-89
Stage 2: SBP >/= 140 or DBP >/=90
BP is based on an average of ≥2 careful readings obtained on ≥2 occasions
Acute elevation of blood pressure, where the systolic blood pressure is >180 mm Hg and/or the diastolic blood pressure is >120 mm Hg
Hypertensive crisis
Hypertensive crisis (systolic blood pressure >180 mm Hg and/or diastolic blood pressure >120 mm Hg) with concomitant end-organ damage
Hypertensive emergency
Targeted end organs:
brain, heart, aorta, kidneys, or eyes
Marked and acutely elevated blood pressure without acute or worsening target organ dysfunction
Hypertensive urgency
Chest pain, back pain Unequal blood pressures (>20 mm Hg difference) in upper extremities
Acute aortic dissection
There is BOV with Retinal hemorrhages and cottonwool spots, hard exudates, and sausage-shaped veins
Hypertensive retinopathy
Is a clinical diagnosis made after excluding focal ischemia or bleeding
Altered mental status, nausea, vomiting, headache
Hypertensive encephalopathy
In this syndrome, acute end-organ dysfunction may not be measurable, but complications affecting the brain, heart, or kidneys may occur in the absence of acute treatment.
Anxiety, palpitations, tachycardia, diaphoresis
Sympathetic crisis
Remarks
Measure blood pressure in both arms in a narrow time interval while the patient is quietly resting. Check blood pressure several times before starting antihypertensive therapy.
Remarks
When an interarm blood pressure difference is detected, treat the higher blood pressure and ensure that subsequent measurements are made on the same arm
Definition of preeclampsia
SBP >/= 140 or DBP >/= 90 on two occasions at least 4 hours apart in pregnant pxs beyond 20wks AOG
Definition of eclampsia
Progression of preeclampsia to new-onset grand mal seizures in the absence of other neurologic conditions that could account for the seizure
Treatment goals
1st hr: Reduce SBP NO MORE THAN 25%
2nd-6th hr: stable: reduce to 160/100
24-48 hrs: To normal BP
Therapeutic goal in acute aortic dissection
SBP: 100 and 120 mm Hg
HR: ≤60 beats/min
ideally within the first hour of presentation
—-»>Reduce shear forces by ↓ BP and PR
T/F: In managing aortic dissection, always use β-blocker prior to vasodilators; nitroprusside alone increases wall stress from reflex tachycardia; cyanide and thiocyanate toxicity in patients with reduced renal function or therapy >24–48 h
T
T/F: Do not give nitrates in patients who have taken phosphodiesterase inhibitors for erectile dysfunction ≤24 h for sildenafil and 48 h for tadalafil
T
first-line agents for cocaine-induced hypertension
Benzodizepines
—-decrease adrenergic stimulation
first-line therapy for pheochromocytoma
Phentolamine
Considered third-line agents in cocaine-induced hypertension after benzodiazepines and nitroglycerin
CCBs
first-line agents in preeclampsia
Hydralazine, labetalol, and nifedipine
contraindicated in hypertensive enceph –> it may worsen cerebral autoregulation
nitroglycerin
In SAH, this is use to decrease mortality. BP control is not its primary goal, but some decrease in BP may be seen
nimodipine
—-lowers blood pressure and reduces v spasm and subsequent cerebral infarction rates, improving neurologic outcomes
used with success in lieu of nimodipine and has similar hypotensive effects
Clazosentan
Goal in ICH
SBP >220: consider aggressive management with IV infusion5
SBP 150-220: IV boluses of antihypertensive medications should be used to acutely lower SBP to 140 mm Hg
Mainstay therapy in acute hypertensive pulmonary edema
nitrates
—reduce blood pressure, decrease myocardial oxygen consumption, and improve coronary blood flow.
Fibrinolytic therapy is contraindicated in patients with ongoing blood pressure ________ mm Hg after antihypertensive therapy.
> 185/110
Avoid in pregnancy and those with myocardial ischemia or bilateral renal artery stenosis
Enalaprilat
contains approximately 0.2 gram of lipid per mL (2.0 kcal). Lipid restrictions may be necessary for patients with significant disorders of lipid metabolism.
Contraindicated in patients with severe aortic stenosis and egg or soy hypersensitivity
Clevidipine
Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*
SBP 130-139 or DBP 80-89
and ASCVD risk <10%
Lifestyle modification and outpatient follow-up
Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*
SBP 130-139 or DBP 80-89
and ASCVD risk >/= 10%
Lifestyle modification; initiate antihypertensive; follow-up in <1 month
Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*
SBP 140-179 or DBP >90-109
Lifestyle modification; initiate antihypertensive therapy (ideally 2 agents); follow-up in <1 month
Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*
SBP >/= 180 or DBP >/=110
Evaluation for target organ damage; initiate lifestyle modification and antihypertensive therapy (ideally 2 agents); prompt outpatient follow-up (within a week)
BP goal
-HF
-Post MI
-High CAD risk
-DM
-CKD
<130/80
BP goal
-Recurrent Stroke Prevention
<140/80
