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Hypertensive Crisis
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What is a hypertensive urgency?
hypertensive crisis with no acute target organ damage
What is a hypertensive emergency?
hypertensive crisis with acute target organ damage
What are the risk factors for hypertensive crisis?
male
elderly
african american
post-op
usually have previous HTN dx
cocaine use
hx of stroke
hx of CHF
What are the clinical sx of HTN emergency?
hypertensive encephalopathy
acute MI/ACS
pulmonary edema (acute CHF)
aortic dissection
acute kidney injury
pre-eclampsia/eclampsia
What are the clinical sx of HTN urgency?
HA
epistaxis
faintness
agitation
How do you do an initial evaluation for HTN crisis?
new sx
med hx
physical exam
quickly assess and implement plan
How do you treat HTN urgency?
slow BP reduction (24-48h)
add new anti-HTN
and/or
increasing dose of current med
or
acute short-acting oral anti-HTN
1-3d follow-up in office
What drugs are used for HTN urgency?
clonidine
captopril (or other ACEI)
labetalol
How do you treat HTN emergency?
immediate BP reduction:
10-15% DBP reduction or to about 110 mmHg (in 30-60 min)
if stable, bring to 160/100-110 (2-6h)
if tolerated, further reduce BP (24-48h)
What drugs are used for HTN emergency?
labetalol
esmolol
nicardipine
fenoldopam
What drugs should be avoided in HTN emergency?
hydralazine
nifedipine
ACEI
clonidine
What is the DOC for HTN crisis with acute MI/ACS?
labetalol or esmolol w/ nitro
What is the DOC for HTN crisis with pre-eclampsia/eclampsia?
labetalol or nicardipine
What is the DOC for HTN crisis with ARF/microangiopathic anemia?
nicardipine or fenoldopam
What is the DOC for HTN crisis with sympathetic crisis/cocaine overdose?
diazepam or lorazepam
phentolamine and nitro (second line)
What is the DOC for HTN crisis with acute postoperative HTN?
esmolol, nicardipine, or labetalol
What drug is CI in glaucoma?
fenoldopam
What drug is CI in acute CHF, asthma or low HR?
BBL
What drug is CI in acute CHF or coronary ischemia?
nicardipine
What drug is CI in renal failure +dehydration or hyperkalemia?
enalaprilat
Author
giddyupp
ID
53085
Card Set
Hypertensive Crisis
Description
Hypertensive Crisis
Updated
2011-01-13T17:22:33Z
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