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8/19/2019 Severe Hypertension

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Severe HypertensionUrgencies and Emergencies
8/19/2019 Severe Hypertension

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8/19/2019 Severe Hypertension

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Presentation

• Asymptomatic

• Non-specific: dizziness, headache etc.

•

Symptoms and sign of acute taget ogandamage: acute coonay syndome, acute heat

fai!ue, sto"e, acute ena! fai!ue, hypetensi#e

encepha!opathy, dissecting aneuysm
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Our Role?•

Histoy (H+N and othe causes)• Physica! eamination

– Pu!se: &ate, hythm, de!ays

– BP

– Pecodium: $ocation and chaacte of ape eat,

Auscu!tate fo heat sounds, eath sounds (iasa!

cepitation)

– Adomen: Pa!pation, auscu!tation fo ena! uit

– Fundoscopy

– %thes

• gent in#estigations: depending on situation / &BS,

*0, uine dipstic" etc.
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Then, patients can be classified:

• Asymptomatic se#ee hypetension

• Hypetensi#e ugencies

• Hypetensi#e emegencies
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Hypertensive Urencies

• 0ade 111 o 12 etina! changes,

poteinuia 34 ut no o#et ogan fai!ue
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!anae"ent

• 5ay e admitted

• 5easuement of BP afte 67 minutes of ed

est

• Aim of theapy: 489 of eduction of BP ut no

!ess than ;7
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Oral treat"ent for HT# urencies

#rug #ose $mg% Onse& o'ac&ion$"our%

#ura&ion$"our%

Fre(uency$prn%

*aptopi! 48 7.8 ; / 4 hous

Nifedipine 7 / 47 7.8 6 / 8 / 4 hous

$aeta!o! 477 / 77 4 ; hous
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Hypertensive $"erencies

• Any patient 'ith comp!ications of se#ee

hypetension i.e. acute taget ogan

damage e#en if BP is !ess than ?7
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!anae"ent

• MUST BE )#M*TTE#

• Aim of theapy: 489 of eduction of BP

depending on scenaio ut no !ess than ;7
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Treat"ent Options for HT#

$"erencies

#rug #ose $mg% Onse& o'ac&ion

#ura&ion .emars

Sodium Nitopusside

7.48 / 7@g
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Treat"ent Options for HT#$"erencies %contd&'

#rug #ose $mg% Onse& o'ac&ion

#ura&ion .emars

Nitates 8 / 77 @g<min

4 / 8 minutes 6 / 8 minutes Pefeed inacute

coonaysyndomesand acute

pu!monayoedema
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Treat"ent Options for HT#$"erencies %contd&'

#rug #ose $mg% Onse& o'ac&ion

#ura&ion .emars

Hyda!azine 12 8 / 7 mgmaye

epeated afte47 / 67minutes477-677mcg
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Treat"ent Options for HT#$"erencies %contd&'

#rug #ose $mg% Onse& o'ac&ion

#ura&ion .emars

Nicadipine 12 o!us 7-67mcg
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