Hypertensive emergencies

Question 1

Define

Answer 1

Hypertensive urgency: SBP >180, DBP >110 and no target end organ damage

Hypertensive emergency: SBP >180, DBP >110 and target end organ damage

Malignant HTN: papilloedema present

Question 2

Airway, Breathing

Answer 2

classic

Question 3

Circulation

Answer 3

Look: sweaty, diaphoresis
Listen: S1,2,0
Feel: CRT, pulse, apex beat

HR
BP (both arms)
ECG
Bloods: UEs, FBC, LFTs, CRP, troponin
Plasma renin, aldosterone
TFTs
Plasma metanephrines/ 24 hr urinary collection

Question 4

Management

Answer 4

Hypertensive urgency:
1. Ora llabetalol orCaV blocker e.g. amlodipine 5mg, nifedipine 24hr MR 20mg (Never use an ACEi due to rapid BP lowering – first dose effect)

Hypertensive emergency: escalate
1. IV labetalol(CI:asthma, heart failure) or hydralazine, sodium nitroprusside
If myocardial ischaemia: GTN
*NB: rapidly lowering BP is dangerous, aim to reduce MAP by 25% over first 24 hours

Escalate:
Seek senior support/ cardiology SpR
HDU/ITU

Question 5

DDx

Answer 5

Uncontrolled essential hypertension
Pain: anxiety Endo: Conns,
phaeo, hyperthyroid
Drugs: ciclosporin, post-surgical vasopressors
Renal: Acute glomerulonephritis

Question 6

D&E

Answer 6

Fundoscopy
urinalysis
ECG
Hx: symptoms (headache, visual problems, CP), drugs, flushing, (pregnancy)