Hypertension

Hypertensive Emergency

Hypertensive Crisis

Hypertensive Crisis

Hypertensive Emergency

Hypertensive Crisis (2 types):

  • hypertensive urgency

  • hypertensive emergency

 

Hypertensive urgency

  • > 180/110 mmHg

  • no associated end-organ damage

  • may have the following symptoms

    • headaches

    • shortenss of breath

    • nosebleeds

    • anxiety

 

Hypertensive emergency

  • > 180/110 mmHg (but can occur at lower pressures if the blood pressure rises acutely)

  • associated with end organ damage

    • stroke

    • loss of consciousness

    • heart attack

    • aortic dissection

    • chest pain

    • pulmonary edema

    • damage to eyes

    • damage to kidney

Nipride (Nitroprusside)

50mg/250mL

MOA: breaks down into NO

maintenance: 0.5-10mcg/kg/min (max 10)

  • thiocyanate levels > 48 hours use

  • decreases preload/afterload

Cyanide toxicity:

  • produces cellular hypoxia

  • electron transport chain inhibited preventing ATP formation

  • coronary steal syndrome

  • ↑ICP (NP impair autoregulation)

  • restlessness, agitation, sinus tachycardia

  • ↑lactic acid

Esmolol (Brevibloc)

2.5g/250mL or 2g/100mL

  • bolus: 500mcg/kg over 1 minute

  • 25-50mcg/kg/min (max: 300); titrate ↑↓every 20minutes

SE: heart block

... but I would more especially commend the clinician who, in acute diseases, by which the bulk of mankind are cutoff, conducts the treatment better than others.
 
Hippocrates, 400 BC