HTN urgency vs emergency

Question 1

define hypertensive crisis and hypertensive urgency vs emergency?

Answer 1

hypertensive crisis: when SBP >=180 and/ DBP >= 120

hypertensive urgency: hypertensive crisis that is asymptomatic or with nonspecific symptoms like headache, dizziness, epistaxis

hypertensive emergency: hypertensive crisis with signs of acute end organ damage involving:
CVD= MI, acute HF, aortic dissection
CNS= stroke, ICH
renal= AKI
retinopathy with papilledema

Question 2

management for hypertensive urgency?

Answer 2

asymptomatic patients: no immediate intervention needed

symptomatic: use rapid-acting oral antihypertensive drug:
clonidine (alpha 2 agonist)
captopril (ACEI)
labetalol (BB)
prazosin (alpha 1 antagonist)

monitor until symptoms improve. OPD follow up within 1 week. counsel on adhering to medications and lifestyle changes

Question 3

management for hypertensive emergency?

Answer 3

admit the patient.
DO NOT lower the MAP more than 25% in the first hour bcz it can lead to hypoperfusion and organ ischemia.

aim is to lower MAP by 10-20% in first hour, then gradually in the next 23 hrs to reach 25% lower than baseline

drugs of choice:
-IV nitroprusside (artery and vein dilator, NO vasodilator)
-IV nitroglycerin (NO vasodilator, dilates arteries and veins but no effect on peripheral arteries)
-IV labetalol
-IV nicardipine (CCB)

in aortic dissection, must RAPIDLY lower BP