Hypertensive Crisis

Question 1

JNC 7 classification for hypertension.

Answer 1

Normal:

Prehypertension: 120/80 to 140/90
Hypertension stage 1: 140/90 to 160/100
Hypertension stage 2: >160/100

Question 2

Main use for “Dynamap” in blood pressure measurements.

Answer 2

Used to find trends

Not diagnostic (use sphygmomanometer for Dx)

Question 3

What is hypertensive crisis?

Answer 3

Acute and severe elevation of blood pressure.

Question 4

Name and describe the two categories of hypertensive crisis.

Answer 4

1. Malignant Hypertension (hypertensive emergency)
   - severe HTN with BP > 220/125 leading to organ failure
2. Hypertensive Urgency
   - severe HTN with BP > 220/125 w/o organ failure

Question 5

Population that most often presents with hypertensive crises.

Answer 5

Patients with uncontrolled or poorly controlled essential hypertension

Question 6

Pathological characteristic seen in Hypertensive Emergency (the one with organ failure) on histology slides indicating a long standing failure of autoregulation and hyperperfusion.

Answer 6

Fibrinoid Necrosis

Question 7

What is the cause of Hypertensive Emergency?

Answer 7

The acute increase in the blood pressure.

The high blood pressure is not the actual cause. It acts more as an indicator

Question 8

How is mean arterial pressure (MAP) calculated?

Answer 8

MAP = 2/3(DBP) + 1/3(SBP)

Question 9

What evidence can indicate aortic dissection in patients in hypertensive emergency?

Answer 9

Back Pain

Question 10

What are characteristics of hypertensive encephalopathy that are observed on physical exam?

Answer 10

Altered level of consciousness
Acute confusional states/delirium
Visual field deficits
Focal deficits, either centrally or peripherally

Question 11

What is the treatment goal for hypertensive emergency?

Answer 11

Reduce MAP by 20% in 1-2 hours with IV antihypertensives.(beta blockers, nitroglycerine, nitroprusside)

Over the next 6-8 hrs. try to drop it to 160/100

Question 12

What is the treatment goal for hypertensive urgency?

Answer 12

Return the blood pressure to normal or near normal levels over 24-48 hrs.

Question 13

What is the risk in treating hypertension associated with strokes?

Answer 13

Treating the hypertension could lead to further hypoperfusion of the brain and exacerbate stroke symptoms.

Question 14

What are side effects and/or contraindications for using:

1. Sodium Nitroprusside
2. Labetolol
3. Esmolol
4. Nitroglycerine
5. Enalaprilat

Answer 14

1. Cyanide Poisoning w/ prolonged use
2. not in 2nd or 3rd degree heart block
3. not in cocaine induced hypertension
4. Not in right sided heart failure
5. Teratogenic

Question 15

Treatment for Eclampsia.

Answer 15

Magnesium Sulfate