Hypertensive Crisis

hypertensive crisis

rapid, significant elevations in systolic and/or diastolic pressures

hypertensive emergency

hypertensive urgency

Two classes of hypertensive crisis that require immediate intervention include

hypertensive emergency

it is life threatening and demands early recognition and management to minimize morbidity and mortality.

is defined as an acute BP elevation greater than 180/120 mm Hg complicated by impending or progressive target organ dysfunction and must be lowered quickly (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs

• hypertension of pregnancy

• acute myocardial infarction

• dissecting aortic aneurysm

• intracranial hemorrhage

Conditions associated with a hypertensive emergency include: HADI

• sodium nitroprusside

• nifedipine

• clevidipine

• enalaprilat

• nitroglycerin

In hypertensive emergency,

The medications of choice in hypertensive emergencies are those that have an immediate effect. ➢ Initial treatment: Intravenous vasodilators, including SNCEN

hypertensive urgency

describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target

Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as this

• Beta-adrenergic blockers

• ACE inhibitors

• Alpha2-agonists

Treatment of Hypertensive urgency include Oral doses of fast-acting agents such as BAA

• Acute kidney failure

• Acute CNS events

• Acute aortic dissection

• Pregnancy-induced eclampsia

• Pheochromocytoma

• Drug-induced hypertension

• Medication-food interactions

In patients with no known history of hypertension, causes of hypertensive emergency include the following: AAA PPDM

Pheochromocytoma

an adrenal tumor that produces epinephrine and norepinephrine and raises blood pressure as a result of the circulating catecholamines

True

The exact trigger of a hypertensive crisis is often unknown. ✓ However, most patients suffer from known hypertension before the event, and the sudden rise in blood pressure is often related to the underlying disease process.

12-lead ECG reading

_____ to evaluate for evidence of acute MI or left ventricular hypertrophy.

2 to 6 hours

The goal of care in hypertensive emergencies is to reduce the blood pressure by no more than 25% within minutes to 1 hour, then towards 160/100 within ___hours.

ischaemia.

It is important to avoid rapid or excessive blood pressure decreases that may lead to renal, cerebral or cardiac ____

every 5-30 minutes

Blood pressure is monitored frequently (every ____ minutes) during a hypertensive emergency.

sodium nitroprusside dihydrate

vasodilator; the first medication used to lower blood pressure in hypertensive emergency.

Onset: seconds

Duration: 1-2 min

Sodium Nitroprusside Dihydrate

Onset:

Duration:

cyanide-like toxicity.

Sodium nitroprusside dihydrate is not suitable for long term use because of development of a metabolite that causes ______ toxicity

Onset: 2-5 mins
Duration: 5-10 mins

Glyceryl trinitrate

Onset:
Duration:

Glyceryl trinitrate

Used when coronary ischaemia accompanies hypertension

Onset: 1-2 mins
Duration: 4-24 hours

Diazoxide

Onset:
Duration:

coronary artery disease (CAD)

Diazoxide are avoided in people with _____

Onset: 10-30 min
Duration: 2-6 hours

Hydralazine

Onset:
Duration:

Hydralazine

• May be used for hypertension associated with eclampsia

• Avoided in people with CHD

labetalol

esmolol

Short-acting beta-blockers that are effective are _______

Beta-blockers are especially effective if aortic dissection is present.

ACEI (Enalaprilat) IV

for patients with heart failure - lowers blood pressure.

Dopamine receptor antagonist (DA1) fenoldopam

for patients with kidney dysfunction - may be used to lower blood pressure and increase blood flow to the kidneys

Diuretic - furosemide (Lasix) IV

for patients with fluid retention

Sometimes, combinations of the above-mentioned agents are more effective in hypertension control.

Hypertension

known as “silent killer”

life-long condition

once identified, it requires monitoring at regular intervals

it can be viewed as risk factor for atherosclerotic cardiovascular disease or it could be considered as a disease itself

increase of cardiac output and increase perioheral vascular resistance or both related to vasoconstriction

a SBP of 140mmHh or higher or a DBP of 90mmHg or higher

less than 120/80

Normal BP

Blood pressure

a product of cardiac output multiplied by perioheral vascular resistance

120-139

80-99

Pre-hypertension

140-159

90-99

Stage 1 Hypertension

greater than or equal to 160/100

Stage 2 Hypertension

greater than or equal to 180/110

Stage 3 Hypertension

• Primary Hypertension

• Secondary Hypertension

Classification of Hypertension

Primary Hypertension

high blood pressure from an unidentified cause

Secondary Hypertension

identified cause. These includes chronic kidney disease, renal artery stenosis, huperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, and sleep apnea

Dopamine Receptor Antagonist (DA1) (Fenoldopam)

for patients with kidney dysfunction

Calcium Channel Blocker

for patients with CNS compromise

• Garlic

• Coenzyme q10 supplement

• Biofeedback

Complementary Medication:

Dash Diet

Diet:

5-15mins

Monitor BP every ___ until diastolic pressure is below 90 and note less than 75; then every 30 mins