Therapeutic Management of Hypertension: Special Populations

Practice flashcards covering definitions, clinical symptoms, drugs, and management goals for hypertensive emergencies, severe hypertension, and special populations like pregnant patients.

Acute Elevated Hypertension

A severe elevation in blood pressure where systolic blood pressure (SBP) is $> 180\text{ mmHg}$ and/or diastolic blood pressure (DBP) is $> 120\text{ mmHg}$.

Severe Hypertension

A severe elevation in blood pressure ($> 180/120\text{ mmHg}$) that is not life-threatening and lacks progressive target organ damage.

Hypertensive Emergency

A potentially life-threatening situation with a severe elevation in blood pressure ($> 180/120\text{ mmHg}$) and evidence of impending or progressive acute target organ damage.

Target Organ Damage (Central Nervous System)

Clinical manifestations including seizures, stroke, or encephalopathy resulting from acute severe hypertension.

Target Organ Damage (Heart/Lung)

Manifestations such as acute coronary syndrome (myocardial infarction), aortic dissection, acute heart failure, or pulmonary edema.

Target Organ Damage (Kidney/Eyes)

Manifestations including acute kidney injury (AKI), acute increase in serum creatinine, proteinuria, blurred/loss of vision, or retinopathy.

Cerebral Autoregulation

The ability of the cerebral vasculature to maintain stable blood flow during blood pressure changes; chronic hypertension shifts this curve to the right.

Severe Hypertension Management Timeline

Blood pressure should be lowered over hours to days ($24-48\text{ hours}$); a reduction of > 25\text{\text{%}} is associated with increased mortality.

Hypertensive Emergency Reduction Goal (1st Hour)

Reduce systolic blood pressure (SBP) by no more than 25\text{\text{%}} within the first hour to maintain cerebral perfusion.

Hypertensive Emergency Reduction Goal (2-6 Hours)

A gradual decrease to a blood pressure of $160/100-110\text{ mmHg}$ following the initial first-hour reduction.

Clevidipine

An IV antihypertensive preferred for acute pulmonary edema; it is contraindicated in patients with egg and soybean allergy.

Esmolol

An IV medication preferred for aortic dissection to help decrease heart rate; should be avoided in acute decompensated heart failure.

Fenoldopam

A dopamine agonist IV medication that is safe for use in patients with renal impairment.

Nitroglycerin

The drug of choice (DOC) for acute coronary syndrome or acute myocardial infarction; avoid if the patient has taken a PDE-5 inhibitor within the last $24\text{ hours}$.

Sodium Nitroprusside

A direct vasodilator and first-line agent for most hypertensive emergencies; it carries a risk of thiocyanate and cyanide toxicity, especially in renal dysfunction.

Chronic Hypertension (Pregnancy)

SBP $\text{≥} 140\text{ mmHg}$ and/or DBP $\text{≥} 90\text{ mmHg}$ diagnosed before pregnancy or before the 20th week of gestation.

Gestational Hypertension

SBP $\text{≥} 140\text{ mmHg}$ and/or DBP $\text{≥} 90\text{ mmHg}$ diagnosed at $\text{≥} 20$ weeks’ gestation.

Preeclampsia

High blood pressure ($\text{≥} 140/90\text{ mmHg}$) after the 20th week of gestation accompanied by proteinuria, edema, or organ damage.

Eclampsia

A severe complication of preeclampsia characterized by the onset of convulsions (seizures).

Resistant Hypertension

Failure to attain goal blood pressure despite adherence to full doses of a $\text{≥} 3$ drug regimen (including a diuretic) or requiring $\text{≥} 4$ drugs.

Pseudo-resistance

Apparent treatment resistance that is ruled out by excluding poor BP measurement technique, white-coat hypertension, or medication nonadherence.

Orthostatic Hypotension

A significant drop in blood pressure when standing from a seated or lying position; high-risk medications include alpha1-receptor antagonists, diuretics, and nitrates.