Hypertensive Crisis Flashcards
What is Hypertensive Crisis?
Urgency or Emergency
What is Urgency Hypertensive Crisis?
SBP > 180 and/or DBP > 120 with NO EVIDENCE of target organ damage
What is Emergency Hypertensive Crisis?
SBP > 180 and/or DBP > 120 with EVIDENCE of target organ damage
What are the signs and symptoms target organ damage?
-Cardiac Ischemia [chest pain, arm numbness, SOB]
-Acute Kidney Injury [decrease urine output, dehydration, vomiting]
-Stroke
-Changes in vision
-Acute pulmonary edema
How many people have Hypertension in America?
About 30% of Americans have HTN
-About 1-2% have a HTN Crisis\
What are the causes of Hypertension Crisis?
Chronic HTN [Increase risk of HTN Crisis], Medication Non-adherence Increase risk of HTN Crisis], Medication and Substance Related, Pregnancy, Renal Disease, Endocrine Disorder
What are the initial work-up steps?
Find out the patients PMH
-Physical: signs and symptoms
-Labs: BUN, Scr, LFT, Electrolytes
-Test: EKG
What are the signs and symptoms of HTN Crisis?
Anxiety, Blurred Vision, Chest Pain, Nausea and Vomiting, Headache.
What are the special situation within a Hypertensive Crisis?
Pre-eclampsia [Pregnancy], Pheochromocytoma Crisis [Neoendocrine Tumor], Aortic Dissection [Tear in the aortia]
What is the goals of therapy for Urgency?
Restart or Start oral medication
-ensure a follow up
What is the goals of therapy for Emergency?
-Hour 1: reduce BP by 25%
-Hours 2 to 6: reduce BP to <160/110
-Hours 6 to 48: reduce BP to goal
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What is the goals of therapy for Special Situations?
-Pre-eclampsia: reduce SBP to <140 in the first hour
-Pheochromocytmia: reduce SBP to <140 in the first hour
-Aortic Dissection: reduce SBP to <120 in the first hour
Why don’t we want to lower BP to patient’s goal if they are having a stoke?
Because you still want blood to get to the brain
What are the rapid-acting oral agents used in Urgency?
Captopril [ACEi], Clonidine [A2 Agonist], Nicardipine [CCB], Labetalol [Nonselective BB]
What is the dosing for Captopril? What are the side effect of Captopril?
-Dosing: 25mg repeated 1-2 hours as needed
-SE: Hyperkalemia, Renal Failure, Angioedema