Definition
What is the difference between hypertensive urgency and emergency?
Urgency- severe elevation in BP w/o signs of end organ damage
Emergency- severe elevation in BP w/ signs of end organ damage
Name two causes of hypertensive crisis.
Renal artery stenosis, hyperaldosteronism, drug use (e.g., cocaine, amphetamines), autoimmune vasculitis and others.
How quickly should blood pressure be reduced?
Over a period of hours to days
How much should you lower BP acutely?
10-20% in the first hour and another 5-15% over the next 24 hours
How does the blood pressure goals change if the patient has an acute stroke?
Don't lower unless it is over 185/110
What is generally used as a cutoff blood pressure for diagnosis?
180/120; however, any significant increase with symptoms would qualify
Which common medications can precipitate a hypertensive crisis when suddenly discontinued?
Clonidine and beta-blockers.
What is the blood pressure target over the first few hours?
To get it below 160/100 or roughly 25-30% over 2-4 hours
According to the ACC/AHA 2017 guidelines, what is the target BP for patients after hypertensive emergency resolution?
Less than 130/80 mmHg
How does the blood pressure goals change if the patient has an acute aortic dissection?
Rapidly lower to systolic of 100-120
Name 3 examples of end organ damage.
Acute kidney injury, pulmonary edema, myocardial infarction, stroke, encephalopathy, aortic dissection, or retinopathy.
What hormonal tumor can cause episodic hypertensive crises?
Pheochromocytoma.
What are two oral medications that can be used to acutely lower blood pressure?
Clonidine and captopril
What are some medications that can be given as boluses to lower BP?
Labetolol, hydralazine
Which antihypertensive medications are safe for use in hypertensive emergencies during pregnancy?
Labetalol, hydralazine, or nifedipine.
True or False: Hypertensive urgency typically requires immediate hospitalization.
False. It can often be managed outpatient with gradual BP reduction.
What physiological process leads to acute kidney injury in hypertensive emergency?
Ischemia from vasoconstriction and reduced renal perfusion.
What medications would you give to a patient that came into your clinic with a BP of 187/102 that was asymptomatic?
What are some IV drips that can be given to act quickly on BP?
What is the most common cause of hypertensive crisis worldwide?
Poor medication adherence
What is the term for a patient that comes in with acutely elevated BP, confusion, headache, nausea and vomiting?
Hypertensive encephalopathy
How does chronic hypertension predispose patients to hypertensive emergencies?
Chronic hypertension causes vascular remodeling and a decreased ability to autoregulate under sudden BP elevations.
What is the difference in 6 month outcomes for treating outpatient vs sending the pt to the ER for the following: Blood pressure control, hospital admission rates and serious cardiovascular complications
A retrospective study of over 50,000 patients showed that the results indicated no difference in blood pressure control or CV complications and lower hospital admission rates for the patients that were set home
Which conditions prevent nitroprusside use?
Acute renal failure and pregnancy (risk of cyanide toxicity)
What is the most common cause of hypertensive crisis in children?
Secondary hypertension from conditions like aortic coarctation or glomerulonephritis/other renal diseases