Medical Flashcards
Classification of hpt crisis
1- HPT urgency- elevation of bp without TOD
2- HPT emergency- elevation of bp with signs of TOD
What are sx of TOD?
1- brain- stroke/TIA, seizure, coma, severe headache
2- eyes- retinopathy, papilloedema
3- heart- LVH, angina/MI, heart failure
4- kidmey- CKD
5- limbs- peripheral arterial disease
Caution on rapid reduction of BP in asymptomatic severe hypertension or hypertensive urgencies?
It may precipitate ischemic events
Mx of HPT urgency
1- repeat BP after 30mins bed rest
2- Aim for reduction 25% over 24 hours, not
Mx of Hypertensive emergency
1- reduce bp rapidly
2- possible complications:
- acute HF
- HPT encephalopathy
- SAH
- acute renal failure
3- aim for reduction by 25% over 3-12 hours
Drugs for hpt emergencies
1- Na nitroprusside 0.25 - 10ug/kg/min
2- labetalol iv bolus 50mg, repeat after 5mins. Max 200mg then IVI 2mg/min
3- nitrates 5-100 ug/min
4- hydralazine iv 5-10mg, repeat after 20-30mins. IVI 200-300mcg/min then maintenance 50-150mcg/min
5- nicardipine iv bolus 10-30mcg/kg over 1 minute then IVI 2-10mcg/kg/min
6- esmolol IV bolus 1-2min 250-500 mcg/kg over 1min
IVI 50-200mcg/kg/min for 4mins. May repeat sequence
What is hypertensive crisis?
Elevation of diastolic bp >120 with or without target organ damage
