Hypertensive Emergencies Flashcards
Stage 1 HTN?
140-159 / 90-99
Stage 2 HTN?
160-179 / 100-109
Stage 3 HTN?
> 180
>110
What is a hypertensive emergency?
A sudden increase in BP associated with end organ damage
How can end organ damage manifest?
Hypertensive encephalopathy Intracerebral/SAH Acute aortic dissection ACS Acute pulmonary oedema Acute renal failure Eclampsia
What is hypertensive urgency?
Severe HTN without evidence of acute end organ damage (although some degree of chronic end organ damage is often present)
How may hypertensive urgency manifest?
Grade 3/4 hypertensive retinopathy
Progressive renal failure
Severe post op HTN
Very high BP
Renal causes of hypertensive crisis?
Renovascular disease (renal artery stenosis, polyarteritis nodosa)
Renal parenchymal disease (acute glomerulonephritis, chronic pyelonephritis)
Systemic disorders with renal involvement (SLE, scleroderma, vasculitis)
Endocrine causes of hypertensive crisis?
Phaeo
Primary aldosteronism
Cushing’s
Other cause of hypertensive crisis?
Pre eclampsia/eclampsia Coarctation aorta Cocaine Ciclosporin EPO Clonidine withdrawal Drug/food interaction with MAOi
What are three pathways for patients with hypertensive crisis?
Admit ICU for I.V Mx, lowering BP over minutes to hours
Admit for oral antihypertensives with regular monitoring, lower BP over 24h
Advise oral antihypertensives, home with follow up
How should I.V therapy be used in hypertensive emergencies?
Titrate to BP control via continuous infusion
Aim 10-15% drop diastolic or diastolic 100-110 within 1-2 hours (exceptions aortic dissection and M.I. where BP needs to be reduced rapidly)
Oral therapy for severe hypertension?
Long acting nifedipine + ca channel blocker (e.g. amlodipine), stop nifedipine once amlodipine starts to work
