Comps - Mod 2 Flashcards
Pre-hypertension BP
120-130/80-90
Stage 1 HTN BP readings
140-159/90-99
Stage 2 HTN BP readings
Greater than 160/greater than120
Hypertensive emergency
Characterized by severe elevation in BP (>180/120 mmHg) complicated by evidence of pending or progressive target organ dysfunction
Target organ dysfunction effects
Heart - LVH, angina prior to MI, prior coronary revascularization, heart failure. Brain - stroke, dementia. Chronic kidney disease. Peripheral arterial disease, retinopathy.
Examples of end target organ damage
Hypertensive encephalopathy. CVA. Acute MI. Acute left ventricular failure with pulmonary edema. Unstable angina. Dissecting aortic aneurysm.
Hypertensive urgency
Elevated BP but NO evidenceo f end organ damage.
Treatment of hypertensive urgency
Oral agents and close follow up - be sure these patients have follow ups scheduled. No evidence to support aggressive use of IV or oral meds for rapid reduction of BP.
Examples of hypertensive urgency - without progressive organ damage
Upper stage II HTN with headache. SOB, epistaxis, anxiety
Hypertensive emergency treatment
Requires immediate BP reduction (not to normal or goal) to prevent target organ damage. Need to be admitted to ICU for continuous monitoring and IV meds.
Initial goal of hypertensive emergency treatment
Reduce BP by no more than 25% within minutes to 1 hr. If stable then to 160/100 in next 2-6 hrs. If stable, gradual reduction toward goal can be achieved over next 24-48 hrs.
Excessive falls of BP
Can precipitate renal, cerebral, or coronary ischemia and should be avoided.
Use of short acting Nifedipine
No longer acceptable in initial treatment of hypertensive emergency or urgency.
Routine tests for all pts with HTN
Urinalysis. CBC. CMP. Fasting glucose. Total cholesterol. Standard 12 lead ECG.
