Hypertensive Crisis Flashcards
What is the difference between hypertensive urgency and crisis
Urgency: Severely elevated BP w/out end organ damage
Crisis: Diastolic >120, end organ damage
What is the initial management of hypertensive crisis
Gradual reduction of map 10-20% within the first hour then 5-15% over the next 23 hours
What is the BP goals for the first hour then the subsequent 23 hours for HTN crisis
First Hour: <180/120
Next 23 hours: <160/110
What is the BP meds of choice for initial managment of htn crisis
Cardene or carvedilol drip plus Esmolol or labetolol
Why is it necessary to avoid rapid reductions in BP
Can produce ischemia
What is the s/s and management of hypertensive encephalopathy
S/s: headache, AMS, n/v
Tx: Goal BP 160/100
What is the BP goal for acute stroke with htn crisis
BP not lowered unless >180/110
If >220/110 not reperfusion candidate
What are the SBP goals for ICH and htn crisis
SBP 130-140 within first six hours
What are pharmacological options for stroke patients with HTN crisis
Labetolol or nicardipine
Can use nimodipine for SAH
What is the pharmacotherapy for LV dysfunction emergency HTN patients
Add a loop diuretic and/or vasodilator to reduce SVR
Avoid BB and hydralazine
Goal: remove excess volume, decrease BP by 10%
What is the pharmacotherapy for ACS HTN crisis
Nitroglycerin, clivedipine, or nicardipine
OR
Nitro plus labetolol
OR
Nitro plus Esmolol
Metoprolol
Management of aortic dissection in HTC
SBP target 100-120
Can use BB and vasodilator
What precedes HTN crisis with sympathetic activity
A discontinuation of anti-hypertensive drugs
Management of HTN crisis with sympathetic activity
Reinstitute discontinued drug
IF cocaine was ingested: add benzos
If guillan baree is suspected: phentolamine, Nitroprusside, or labetolol
What is malignant hypertension
Abrupt increase in blood pressure
Rate of rise more important than level of BP
Organ damage
Cause:
◦ Diffuse necrotizing vasculitis
◦ Arteriolar thrombi
◦ Fibrin deposition in arterial walls
◦ Fibrinoid necrosis
