Hypertensive Crises General

Question 1

Hypertensive emergency definition

Answer 1

Severe elevations in blood pressure (usually greater than 180/120 mm Hg) with evidence of new or worsening target-organ damage:encephalopathy, intracranial hemorrhage, acute ischemic stroke, or other acute neurologic deficit; UA or acute MI; acute LV failure with pulmonary edema; dissecting aortic aneurysm; retinopathy or papilledema; decreased urinary output or acute renal failure; eclampsia

Question 2

Hypertensive urgency definition

Answer 2

Situations associated with severe blood pressure elevation in otherwise stable patients without
acute or impending change in target-organ damage or dysfunction

Question 3

Hypertensive urgency treatment

Answer 3

reinstitution or intensification of antihypertensive drug therapy, should be reevaluated within 7 days (preferably after 1–3 days).

Question 4

Acute aortic dissection Preferred Agents

Answer 4

Labetalol, esmolol

Question 5

Acute aortic dissection Treatment Strategy

Answer 5

β-blocker should be given before vasodilator if needed for BP control or to prevent reflex
tachycardia or inotropic effect; SBP ≤ 120 mm Hg should be achieved within 20 min

Question 6

Acute coronary syndromes Agents

Answer 6

Esmolol or NTG
(preferred), labetalol,
nicardipine

Question 7

Hypertensive emergency General Treatment Strategy

Answer 7

Lower MAP by no more than 25% in the first hour; then reduce SBP to 160 mm Hg and DBP to 100–110 mm Hg over next 2–6 hours; then to normal over next 24–48 hours

Question 8

Acute pulmonary edema agents

Answer 8

Clevidipine, NTG, NTP

Question 9

Acute renal failure agents

Answer 9

Clevidipine, fenoldopam,
nicardipine

Question 10

Perioperative HTN Definition

Answer 10

BP ≥ 160/90
mm Hg or SBP elevation > 20% of the preoperative value that persists > 15 min

Question 11

Perioperative HTN agents

Answer 11

Clevidipine, esmolol,
nicardipine, NTG

Question 12

Acute sympathetic discharge or catecholamine excess states agents

Answer 12

Clevidipine, nicardipine,
phentolamine
(Note: Avoid unopposed
β-blockade)

Question 13

Eclampsia or preeclampsia agents

Answer 13

Labetalol, nicardipine,
hydralazine (second line)
ACE inhibitor, ARBs, renin inhibitors, and NTP contraindicated

Question 14

Eclampsia or preeclampsia treatment strategy

Answer 14

Requires rapid BP lowering to < 140 mm Hg within first
hour

Question 15

Acute intracranial hemorrhage agents

Answer 15

IV continuous infusion; Avoiding medications that can increase ICP and worsen cerebral ischemia (hydralazine,
NTG, and NTP)

Question 16

Acute intracranial hemorrhage treatment strategy

Answer 16

Lower BP in those who present with SBP > 220 mm Hg with continuous IV infusion and close BP monitoring

Question 17

Acute ischemic stroke treatment strategy

Answer 17

Do not lower blood pressure in acute ischemic stroke unless greater than 220/120 mm Hg or greater than 185/110 mm Hg in tissue plasminogen activator candidates