Background
Normal Blood Pressure
DBP < 80 mmHg
Hypertensive Urgency can usually be treated in what setting?
What formulations of medications should initially be administered to patients presenting with hypertensive emergency?
IV
Major side effect of nitroglycerin?
Headache
Major drug interaction with Nitroglycerin
PDE5 Inhibitors
Name 3 risk factors for the development of hypertensive crisis
1) Non-adherence to medications
2) Increases in dietary sodium
3) Medications
4) Anxiety/Panic Attacks
5) Acute Strokes
6) Heart Failure
It is important to instruct patients to do what after being discharged from the hospital due to a hypertensive crisis
Follow up with their primary care provider
According to the 2017 ACC/AHA Guidelines, patients presenting with hypertensive emergency should be treated where?
Intensive Care Unit
Clevidipine is contraindicated in what types of patients?
Patient is allergic to soy/egg products
Max Dose of Nicardipine in hypertensive crisis according to presentation and LH Code Card
15 mg/hr
Name 2 goals of therapy in patients presenting with hypertensive crisis
2) Minimize Target Organ Damage
3) Reduce complications
4) Prevent long term recurrence
Important first two steps in determining treatment options
Determining anti-hypertensive regimen
Determining adherence to regimen
Name 4 examples of target organ damage
1) Heart --> acute MI, unstable angina, dissecting aortic aneurysm, acute pulmonary edema
2) Brain --> AIS, TIA, ICH/SAH, encephalopathy
3) Renal --> AKI, Hematuria
4) Eyes --> Retinopathy
5) Vascular --> Aortic aneurysm
Max Dose of Nitroglycerin in hypertensive crisis according to presentation at LH Code Card
200 mcg/min
What medication is associated with the development of tachyphylaxis if use is continued for 24-48 hours?
Nitroglycerin
Number 1 risk factor for the development of hypertensive crisis
Medication non-adherence
Goal Reduction in blood pressure for patients presenting with hypertensive urgency
< 160/100 mmHg in 24-48 hours
Patients presenting with aortic dissection should have their SBP lowered to less than ___ mmHg within the first hour.
Labetalol is guideline recommended for patients presenting with hypertensive crisis caused by _______.
Eclampsia or pre-eclampsia during pregnancy
What medication/medication class is contraindicated in patients presenting with hypertensive crisis who are also pregnant?
Enalaprilat
Hypertensive crisis accounts for what percentage of emergency department visits?
4.6%
Two options for patients who present with hypertensive urgency who are determined to be adherent to their outpatient anti-hypertensive regimen.
1) Increase the dose of current medication
2) Add on addition medication
Blood pressure lowering goals in patients presenting with hypertensive emergency but without compelling condition
Reduce MAP by max of 25% over the first hour --> reduce BP 160/100-110 over the next 2 to 4 hours --> reduce to normal over the next 24-48 hours
Why should hydralazine be avoided in patients with acute ischemic stroke or acute myocardial infarction?
Potential for causing reflex tachycardia
Dose adjustment criteria to 0.625 mg IV for enalaprilat
2) CrCl < 30 mL/min
3) SCR > 3 mg/dL
4) Patients with concomitant heart failure