Systemic Hypertension Flashcards
Meaningful interarm BP difference which increases long-term risks of CV events and mortality
> 10 to 12 mmHg
Acute neurologic MRI findings that demonstrate reversible edema that is predominantly seen in occipital area
Posterior Reversible Encephalopathy Syndrome
A clinical diagnosis made after excluding focal ischemia or bleeding in patient presenting with elevated BP with AMS, headache, vomiting, seizures or visual disturbance sometimes papilledema
Hypertensive Encephalopathy
Hypertensive encephalopathy (defined as a change in sensorium or seizure from the blood pressure elevation) warrants rapid and uniform blood pressure reduction once other neurologic emergencies, notably ischemic or hemorrhagic stroke, are excluded
Four settings in which excess of catecholamines can result in a hypertensive emergency
- Abrupt discontinuation of clonidine that is potentiated by concomitant BB therapy
- Pheochromocytoma
- Sympathomimetic drug - cocaine, amphetamines, phency- clidine hydrochloride, and lysergic acid diethylamide
- Autonomic dysfunction
BP goal in Hypertensive Emergency
Use parenteral antihypertensive agents to reduce systolic blood pressure no more than 25% in the first hour; if stable, then reduce to 160/100 mm Hg over the next 2 to 6 hours and then to normal over the following 24 to 48 hours
Medication of choice for Eclampsia/Preeclampsia: 1st line
Hydralazine, labetalol, and nifedipine are all considered first-line agents. Nifedipine is ideal if IV access cannot be established
Contraindicated: ACE inhibitors, ARBs, renin inhibitors, and nitroprusside
First-line agents for cocaine-induced hypertension
Benzodiazepines are first-line agents for cocaine-induced hypertension i.e. Lorazepam, Diazepam
to decrease adrenergic stimulation
Benzodiazepines may induce respiratory depression; monitor patients closely
if not effective: may add Nitroglycerin/Phentolamine
3rd line: CCB
Do not give this medication in patient with Hypertensive Encephalopathy as it may worsen cerebral autoregulation
Nitroglycerin dilates cerebral arteries and alters both global and regional blood flow, which may worsen the autoregulation failure
Medication used in SAH to decrease mortality but is not used for BP control
Nimodipine
Therapeutic goal in Acute aortic dissection
The therapeutic goal in acute aortic dissection is a systolic blood pressure between 100 and 120 mm Hg and a heart rate ≤60 beats/min, ideally within the first hour of presentation.
new: HR 60-80
Patients presenting with severely elevated blood pressure and ischemic changes on ECG should be treated with what medication
Sublingual or IV nitrates
Meds for Cocaine-induced hypertension, except
a. CCB
b. Betablockers
c. NTG
d. phentolamine
e. NOTA
β-blockers can result in unopposed α-blockade, which then can worsen coronary vasoconstriction and increase blood pressure.44 If a β-blocker is selected, labetalol, due to its α-adrenergic blocking effects, should be used in conjunction with a vasodilator.4
First-line agent for patients with pheochromo- cytoma and a hypertensive emergency.
IV phentolamine is the first-line agent for patients with pheochromo- cytoma and a hypertensive emergency.
Second-line agents include clevidipine and nicardipine.7
Phenoxybenzamine, a long-acting oral adrenergic α-receptor blocker, is used only in the preoperative setting in patients who are hypertensive but not in crisis.
Used only in the preoperative setting in patients who are hypertensive but not in crisis.
Phenoxybenzamine, a long-acting oral adrenergic α-receptor blocker, is used only in the preoperative setting in patients who are hypertensive but not in crisis.
this reduce systemic vascular resistance while preserving renal blood flow
Fenoldopam, nicardipine, and clevidipine are all suitable for acute hypertension-induced isolated renal failure, because they reduce systemic vascular resistance while preserving renal blood flow.
Fenoldopam improves natriuresis and creatinine clearance in patients with
45 elevated blood pressure and impaired renal function.
