SYSTEMIC AND PULMONARY HYPERTENSION SYSTEMIC HYPERTENSION

Question 1

Hypertensive emergency is

Answer 1

an acute elevation of blood pressure (180/120 mm Hg) associated with end-organ damage, specifically, acute effects on the brain, heart, aorta, kidneys, and/or eyes

Question 2

Hypertensive urgency

Answer 2

is a clinical presentation associated with severe elevations in blood pressure without progressive target organ dysfunction.

Question 3

Posterior reversible encephalopathy syndrome can be associated with (3)

Answer 3

immunosuppressant therapy,
erythropoietin use,
high-dose steroid therapy.

Question 4

Aortic dissection Rx

Answer 4

Labetalol IV continuous drip
EsmololIV, bolus, then continuous drip
NicardipineIV continuous drip (after -blocker)
Nitroprusside continuous drip (after -blocker)

Goals:
SBP 100-120 mm Hg,
HR

Question 5

Acute hypertensive pulmonary edema Rx

Answer 5

Nitroglycerin SL, topical, or IV continuous drip
Enalaprilat IV
Nicardipine IV continuous drip
Nitroprusside IV continuous drip
Goal:
Reduction of BP by 20%-30%.
Promotion of diuresis after vasodilation.
Symptomatic relief.
Risk:
Hypotension (enalaprilat).
Exacerbation of renal dysfunction (diuretics and ACE inhibitors).
Lower survival rates with diuretics alone

Question 6

Acute sympathetic crisis (cocaine, amphetamines) Rx

Answer 6

Benzodiazepine IV bolus
Nitroglycerin SL, topical, or IV continuous drip
Phentolamine
Nicardipine IV continuous drip

Unopposed beta-blockade can cause storm and increase cocaine toxicity.
Labetalol has been used in this setting, but is not recommended
Most hypertension will resolve with time and benzodiazepines.
Watch respiratory rate.

Question 7

Hypertensive encephalopathy Rx

Answer 7

Nicardipine IV continuous drip
Labetalol IV continuous drip
Fenoldopam IV continuous drip
Decrease MAP 15%-20%.

Question 8

Subarachnoid hemorrhage Rx

Answer 8

Labetalol IV continuous drip
Nicardipine IV continuous drip
Esmolol IV, bolus, then continuous drip
SBP 120 to preserve cerebral perfusion.

Question 9

Intracranial hemorrhage Rx

Answer 9

Labetalol IV bolus, or continuous drip
Nicardipine IV continuous drip
Esmolol IV, bolus, then continuous drip
For patients with any evidence of potential elevation of ICP,* treat elevated BP to target MAP of 130 mm Hg.
If there is no clinical suspicion of elevated ICP, treat to MAP of 110 mm Hg, or SBP of 160 mm Hg.

Question 10

Acute ischemic stroke Rx

Answer 10

Labetalol,IV bolus (start with 10 milligrams), or continuous drip
Nitroglycerin
Nicardipine IV continuous drip
If fibrinolytic therapy planned, treat if >185/110 mm Hg.
Treat if >220/120 mm Hg on third of three measurements, spaced 15 min apart.
Lowering of BP may significantly worsen ischemia and deficit.
Lowering of BP by >10%-15% in first 24 h should be avoided.