HYPERTENSIVE EMERGENCIES

Question 1

Hypertensive crisis

Answer 1

severe and potentially life threatening
increase in blood pressures (BP) which may result in an acute stroke,
subarachnoid haemorrhage, seizures (hypertensive encephalopathy),
heart attack, acute dissection of aorta, heart failure, renal damage or
eclampsia (during pregnancy).

Question 2

BP threshold for hypertensive emergencies

Answer 2

180/120

Question 3

Symptoms of hypertensive emergencies

Answer 3

Headache
Chest pain
Shortness of breath
Nausea
Vomiting
Confusion
Seizures
Unconsciousness

Question 4

Signs of hyperensive emergencies

Answer 4

Severely elevated blood pressure (for age)
Unconsciousness
Seizures
Neck rigidity
Lung crepitations

Question 5

Investigations done in hypertensive emergencies

Answer 5

12-lead ECG
FBC
Urinalysis
BUE/Cr
Brain CT scan
Chest CT scan with angiography
Cardiac enzymes
Echocardiography

Question 6

Purpose of chest CT with angiography in hypertensive emergency

Answer 6

Aortic dissection

Question 7

Treatment objectives in hypertensive emergencies

Answer 7

To limit further organ-related complications by controlled reduction
of BP
To control and subsequently prevent seizures if present
To manage identified target organ damage

Question 8

Treatment of hypertensive emergencies

Answer 8

IV Labetalol
or
IV Hydralazine

Question 9

Labetalol dose in hypertensive emergency

Answer 9

Adults
20-50 mg stat. (over a 2 minute period)
Repeat at 10 minute intervals, if necessary, to a max. of 200 mg

Children
12-18 years; 10-30 mg stat. (over a 2 minute period).
Repeat at 15
minute intervals, if necessary (max. 200 mg)
1 month-12 years (by IV infusion)
initially 500-1000 microgram /kg
body weight / hour adjusted at intervals of at least 15 minutes according
to response. Max. 3 mg /kg/hour.

Question 10

Hydralazine dose in hypertensive emergency

Answer 10

Adults
5-10 mg slowly (over a 2 minute period), diluted with 10 ml Normal
Saline (0.9%).
Repeat at 20-30 minute intervals, if necessary

Children
12-18 years; 5-10 mg stat.
Repeat every 4-6 hours, if necessary

1 month-12 years; 100-500 microgram/kg
Repeat every 4-6 hours, if necessary; max. 3 mg/kg daily (not exceeding
60 mg per day)

< 1 month; 100-500 microgram/kg
Repeat every 4-6 hours, if necessary; max. 3 mg/kg daily

Question 11

Labetalol injections should be stopped when BP is ……………… and or pulse < …………

Answer 11

<140/90
<60