Hypertensive Crisis Flashcards
what is hypertensive urgency
> 180/120
no evidence of target organ damage
what is hypertensive emergency
> 180/120
evidence of target organ damage
symptoms of target organ damage
headache
chest pain
shortness of breath
back pain
numbness/weakness
change in vision
difficulty speaking
what are the common causes of hypertensive emergency
chronic HTN
medication non-adherence
medication/substance related
pregnancy
renal disease
endocrine disorders
goals of hypertensive urgency
restart/intensify antihypertensive therapy
treat anxiety if applicable
what NOT to do with hypertensive urgency
don’t send to ER
don’t immediately reduce BP
don’t hospitalize
goals of hypertensive emergency
hour 1: reduce BP by max of 25%
hour 2-6: reduce BP < 160/100-110
hour 6-48: reduce BP to goal
what to do in hypertensive emergency
refer to ER
hospital admission
IV antihypertensive
what types of medications should be used to treat hypertensive emergency
-IV meds
-fast onset/offset
-predictable pk
-minimal AE
nicardipine pros
titratable
low risk of AE
nicardipine cons
contraindicated in severe aortic stenosis
titrate cautiously with renal/hepatic impairment
reflex tachycardia
clevidipine pros
titratable
worse AE
clevidipine cons
contraindicated in severe aortic stenosis
lipid formula (CI with soy/egg allergy)
change IV every 12 hours
induces AFib
nitroglycerin pros
titratable
beneficial in coronary ischemia
sodium nitroprusside pros
titratable
nitrates cons
tolerance with prolonged use (max 24-48 hrs)
dose-limiting headache and reflex tachycardia
caution with high ICP
excessive hypotension in hypovolemia
nitroprusside only (cyanide toxicity)
hydralazine pros
can be used in bradycardia
hydralazine cons
not titratable
less predictable
rebound tachycardia
labetalol pros
decreases HR and BP
titratable
labetalol cons
CI with severe bradycardia, ADHF, reactive airway diseases
esmolol pros
decreases HR
cardioselective (good for reactive airway diseases)
esmolol cons
adjunct therapy not mono
avoid in severe bradycardia and ADHF
enalaprilat pros
beneficial in emergencies related to renin excess
enalaprilat cons
delayed onset and peak
CI in AKI, hyperkalemia, acute MI, pregnancy
clonidine pros
PO option
clonidine cons
often inappropriate in HTN emergency
delayed onset
can cause hypertensive crisis on withdrawal
how does decompensated HF with PE affect drug therapy
prefer nitrates
avoid BB and non DHPs
how does aortic dissection affect drug choice
start BB then vasodilator
lower BP quickly and prevent tachycardia
how does acute coronary syndrome affect drug choice
IV drip drugs
avoid BB or non-DHP
how does AKI affect drug choice
most IV choices are acceptable
avoid enalaprilat
how does eclampsia affect drug choice
first choice is hydralazine, labetalol, or nicardipine
CI with enalaprilat and nitroprusside
how does stroke affect drug choice
want nicardipine, clevidipine, or labetalol
