Hypertension

Question 1

Define:
- Hypertension
- Severe hypertension
- Hypertensive Urgency
- Hypertensive Emergency

Answer 1

HYPERTENSION
- >140 / 90

SEVERE HYPERTENSION
- > 180/120

URGENCY (AKA Severe Asymptomatic HTN)
- No acute end-organ
- Headache, proteinuria DON’T count

EMERGENCY (AKA Malignant HTN)
- Ccute end-organ** effects
–> *eg. Encephalopathy, SAH, stroke, APO, dissection, MI, renal failure, pre/eclampsia/HELLP

Question 2

Management of hypertensive urgency (Severe Asymptomatic HTN):

Answer 2

Commence oral antihypertensive (eg. amlodipine, ramipril)

GP follow up

Aim reduction over 1-2 days

Question 3

Management of hypertensive emergency incl targets:

Answer 3

• Esmolol 0.5mg/kg IV –> 50microg/kg/min
  OR
• Labetalol 10 -20 IV–> 1mg/min
  OR
• GTN 2.5mg/hr titrated
  OR
• Hydralazine 10-20mg IV, Q20min or 5mg/hr
  OR
  SNIP
  ……….Or as per specific process.

Targets:
- Symptom resolution
- BP reduction of 20%
- Over 1-2 hours

Aggressively pursue specific target in:
- Pre-thrombolysis
- Dissection

Question 4

Causes of secondary HTN:

Answer 4

Vascular
- Dissection

Renal
- Renal artery stenosis
- Nephritic syndrome

Endocrine
- Thyrotoxicosis
- Cushings
- PCOS
- Phaeo

*Tox
- Withdrawal (ETOH, clonidine, BB)
- Stimulants *(cocaine, amphet)
- Serotonin syndrome
- Irukandji

Autonomic instability (SCI)