Emergency/urgent Hypertension

Question 1

Hypertensive urgency SBP and DBP parameters

Answer 1

SBP greater than 220mm Hg

DBP greater than 125 mm Hg

Question 2

Other than BP parameters what can be indicative of hypertensive urgency

Answer 2

May or may not have optic disk Edema

No signs of end organ damage

Question 3

In HTN urgency when must the BP must be reduced

Answer 3

Within Few hours

Question 4

Hypertensive emergency BP

Answer 4

Strikingly elevated DBP greater than 130mm Hg

Question 5

What are the signs of End organ damage

Answer 5

Encephalopathy 
Intracranial hemorrhage 
Ischemic stroke 
Nephropathy 
Unstable angina, AMI, CHF, or aortic dissection 
Pulmonary edema

Question 6

In emergency HTN BP must me reduced within how many hours and at what percentage

Answer 6

1-2 hrs

25% ( <160/110 in 24 hours )

Question 7

Main goal of the PE in HTN emergency

Answer 7

Is to evaluate for signs of end organ damage

Question 8

During the neurological examination what are some findings in HTN emergency

Answer 8

Neurological deficits 
Mental status changes 
Changes in vision
HA
N/V

Question 9

Cardio/pulmonary exam looking for?

Answer 9

Signs of heart failure ( S3, new murmurs)
Carotid bruits
Pulmonary edema
Sudden c/o SOB chest px

Question 10

In fundoscopic examination looking for?

Answer 10

Papilledema or hemorrhage

Question 11

Labs

Answer 11

UA ( proteininuria or hematuria)
Comprehensive metabolic panel ( renal or liver dysfunction)
Troponins( myocardial injury)

Question 12

Images/studies

Answer 12

EKG ( signs of AMI)
Chest xray ( widened mediastinum ( aortic dissection) or pulmonary edema
CT head or aorta ( if indicated)

Question 13

Treatment for urgency

Answer 13

If already on meds, re-initiate it

If not on meds, use oral alpha blocker or beta blockers

Question 14

Oral alpha blocker give

Answer 14

Clonidine

Question 15

Beta blocker

Answer 15

Metoprolol or labetalol

Question 16

Emergency HTN treatment

Answer 16

IV
O2 ( if <94%) monitor with telemetry
after lower BP by 25%, start to slowly reduce BP
Start with Labetalol 20mg IV ( over 10 minutes) than 40-80mg IV q10 min PRN, max 300mg

Question 17

For emergency, once stable switch to which medication?

Answer 17

Metoprolol 25-50 mg PO twice daily

Question 18

What can occur if the BP is lowered to quickly in an emergency HTN

Answer 18

May precipitate renal, cerebral or coronary ischemia

Question 19

Initial treatment

Answer 19

Look for signs of End of organ damage
Hypertensive urgency: PO medications
Hypertensive emergency: IV medication
You need to stabilize and transfer to higher level of care/MEDEVAC

Question 20

Complications

Answer 20

Aortic dissection 
AMI
Ischemic stoke
Hemorrhagic stroke
Acute kidney injury 
Retinal hemorrhage and blindness 
CHF with pulmonary edema and acute  respiratory failure 
Death