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Hypertension Crisis

M. Vejdanparast MD.Cardiologist

M.Vejdanparast

Introduction

Majority of patients presenting in ER with BP> 180 do not have a hypertensive emergencies or urgencies.

This patients can safely sent home with oral medication & arrangements made for F/U.

M.Vejdanparast

Definition

• Normal : <120/80

• Pre HTN: 120-139/80-89

• Stage I: 140-159/90-99

• Stage II: >160/100

• Severe HTN: 160/100 - 220/130

• Hypertensive urgency: >220/130 or Symptomatic HTN (without EOD)

• Hypertensive Emergency: HTN + EOD

M.Vejdanparast

Triage

Group 1 Group 2 Group 3

Symptoms Anxiety Asymptomatic

Headache Dyspnea Epistaxis

Sever headache Chest pain/Dyspnea Dysarthria

Examination No EOD Previous EOD New EOD

TreatmentDischarge or Observe 1-3h No therapy F/U>72h

Observe 3-6h Oral therapy F/U<24

IV therapy ICU admission

M.Vejdanparast

Severe HTN

Group 1

Symptom Anxiety Asymptomatic

Examination No EOD

Treatment Observe 1-3h No therapy F/U>72h

Hx of HTN

Yes No

Previous BP

ControlledUnControlled

New Case

Group 1

M.Vejdanparast

Urgent HTN

Drug Onset

Captopril 25mg 15-30min

Clonidine 0.1-0.2mg 30-60min

Inderal 40mg 20min

Frusemide 40mg 30min

Target Decreased 25% MAP ( 4-6h ) PO Medications

Group 2

M.Vejdanparast

Emergent HTN

Hypertensive crisis with retinopathy or acute renal insufficiency

Hypertensive encephalopathy

Acute aortic dissection

Acute pulmonary edema

Acute coronary syndrome

Acute ischemic stroke and BP >220/120 mm Hg

Acute ischemic stroke with indication for thrombolytic therapy and BP >185/110

Cerebral hemorrhage and SBP >180 mm Hg or MAP >130 mm Hg

Severe preeclampsia/eclampsia

Group 3

Emergent HTNGroup 3

Target Witch Organ Is Damaged?

M.Vejdanparast

M.Vejdanparast

Emergent HTNEmergent HTNGroup 3

M.Vejdanparast

Emergent HTN

Contraindicated Nitroprusside Nitroglycerin Hydralazine

Emergent HTNGroup 3

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Thank You