Chapter 9 - Hypertensive crisis

Question 1

list 3-4 cardiac signs of hypertensive crisis

Answer 1

L ventricular hypertrophy, systolic murmur, arrhythmia, more rarely heart failure

Question 2

4 organs at risk of damage from hypertension

Answer 2

eye, brain > kidneys, heart

Question 3

target BP in hypertensive patients

Answer 3

110-150mmHg SAP

Question 4

ACVIM classification system for hypertension based on risk of target organ damage

Answer 4

AP0(I) SAP <150mmHg, DAP <95
AP1(II) SAP 150-159, DAP 95-99
AP2(III) SAP 160-179, DAP 100-119
AP3(IV) SAP >/= 180, DAP >/=120

Question 5

define hypertensive emergency

Answer 5

SAP >/= 160 + evidence of new/progressive target organ damage

Question 6

define hypertensive urgency

Answer 6

SAP>/= 160, no evidence target organ damage

Question 7

recommendation for BP lowering in hypertensive emergency

Answer 7

no more than 25% in first 1h, target 110-160 in 2-6h

Question 8

does hypertension + epistaxis = hypertensive emergency?

Answer 8

without further evidence of target organ damage, this is hypertensive urgency not emergency

Question 9

how does body prevent acute changes in BP?

Answer 9

autonomic nervous system

Question 10

how does body regulate BP changes over minutes to hours? (3 mechanisms)

Answer 10

RAAS, fluid shifts between intravascular and interstitial space, stress relaxation responses of vasculature

Question 11

how does body regulate BP in the long term

Answer 11

kidneys - control of extracellular fluid volume

Question 12

how may oxidative stress potentially contribute to hypertension?

Answer 12

decreased nitric oxide bioavailability = increased SVR

Question 13

what factor always contributes to hypertension? what may or may not contribute?

Answer 13

inappropriate SVR, +/- increased blood volume

Question 14

signs of hypertensive retinopathy

Answer 14

acute blindness, intraocular haemorrhage, retinal detachment most common
also: retinal vessel tortuosity, edema, retinal degeneration

Question 15

in a patient with hypertension, retinal detachment and blindness, will lowering BP correct ocular disease?

Answer 15

retina may reattach, blindness often permanent, subsequent retinal degeneration may still occur

Question 16

neurological signs consistent with hypertensive injury? 2 commonest injuries + imaging findings?

Answer 16

altered mentation, disorientation, lethargy, seizures, balance disturbances, head tilt, nystagmus, behaviour changes, focal neurologic deficits
DDx hypertensive encephalopathy (white matter edema, vascular lesions) or hemorrhagic or ischemic stroke

Question 17

DDx for hypertension in a patient with neurologic disease

Answer 17

cushings reflex v hypertensive target organ damage (hypertensive encephalopathy or hemorrhagic/ischemic stroke)

Question 18

lab findings with hypertensive renal injury

Answer 18

proteinuria, elevated UPC, progressive decline in renal function

Question 19

4 most common causes of secondary hypertension

Answer 19

DM, hyperA, hyperT, renal disease

Question 20

5 less common causes of hypertension

Answer 20

primary/idiopathy, pheo, hyperaldosteronism, hepatic disease, polycythemia, chronic anaemia, CHF, neoplasia, iatrogenic (drug induced)

Question 21

risk if drop BP too quickly in hypertensive emergency?

Answer 21

ischemia of target organs

Question 22

frequency of BP monitoring & target organ evaluation during treatment of hypertensive emergency/urgency

Answer 22

q8-12h at least

q1-3h if parenteral treatment