HYPERTENSIVE CRISES (EMERGENCY AND URGENCY) TREATMENT, HYPERTENSIVE EMERGENCY MANAGEMENT ALOGRITHAM

Summary

This video discusses hypertensive crisis, distinguishing between hypertensive emergency and urgency based on the presence of end organ damage. It emphasizes the importance of gradual blood pressure reduction to avoid stroke, with oral medications for urgency and IV drugs like labetalol and nitroprusside for emergencies. The script provides a clear guideline on managing these conditions step by step.

Takeaways

• 📈 Hypertensive crisis is defined as a systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg.
• 🚨 The presence of end-organ damage differentiates between hypertensive emergency and urgency; the former requires immediate treatment.
• 🩺 Signs of end-organ damage include myocardial infarction, unstable angina, acute renal failure, ischemic stroke, intracerebral hemorrhage, and hypertensive encephalopathy.
• 🛌 Hypertensive urgency is managed by controlled reduction of blood pressure over days to avoid the risk of stroke from sudden drops.
• 💊 Oral medications, such as atenolol or long-acting calcium channel blockers, are typically used to treat hypertensive urgency.
• 🏥 Hypertensive emergency mandates rapid but controlled blood pressure reduction within hours due to severe symptoms and organ damage.
• 🩹 In hypertensive emergency, intra-arterial lines are used for blood pressure monitoring and to ensure gradual reduction.
• 🚫 Avoid rapid blood pressure drops, even in emergencies, to mitigate the risk of stroke; aim for a reduction of no more than 25% in the first two hours.
• 💉 Intravenous medications like labetalol and sodium nitroprusside are used for rapid blood pressure control in hypertensive emergencies.
• 🈲 Do not use sublingual nifedipine for blood pressure reduction in hypertensive emergencies due to the risk of causing a stroke from rapid drops.
• 🔄 The treatment approach for hypertensive crisis involves a careful balance of reducing blood pressure while minimizing the risk of stroke.

Q & A

What is defined as a hypertensive crisis?

A hypertensive crisis is defined as a systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg.

How is hypertensive crisis differentiated from hypertensive emergency?

Hypertensive crisis is differentiated from hypertensive emergency by the presence or absence of end-organ damage. If end-organ damage is present, it is called a hypertensive emergency.

What are some examples of end-organ damage that may indicate a hypertensive emergency?

Examples of end-organ damage include myocardial infarction, unstable angina, acute renal failure, ischemic stroke, intracerebral hemorrhage, and symptoms of hypertensive encephalopathy such as headache, confusion, and altered mental status.

What is the primary goal of treating hypertensive urgency?

The primary goal of treating hypertensive urgency is controlled reduction of blood pressure over days, not in hours, to avoid the risk of stroke due to sudden blood pressure drop.

Which medications are typically used to treat hypertensive urgency?

Oral medications such as atenolol and long-acting calcium channel blockers are typically used to treat hypertensive urgency, aiming to slowly bring blood pressure back to a normal range.

How is blood pressure reduction managed in hypertensive emergency?

In hypertensive emergency, blood pressure is reduced more rapidly than in urgency, but still not too quickly to avoid increasing the risk of stroke. The diastolic blood pressure is reduced by almost 25% over the first two hours, and then further reduced to a level of 160/200 over the next two to six hours.

What intravenous medications are used in the treatment of hypertensive emergency?

Intravenous medications such as labetalol and sodium nitroprusside are used for rapid blood pressure reduction in hypertensive emergency.

Why is it important to avoid using sublingual nifedipine in hypertensive emergencies?

Sublingual nifedipine is avoided because it can cause a rapid drop in blood pressure, which can lead to stroke.

What is the recommended approach to reducing blood pressure in the first two hours of hypertensive emergency treatment?

The recommended approach is to avoid decreasing blood pressure by more than 25% in the first two hours to minimize the risk of stroke.

What is the purpose of monitoring blood pressure through an intra-arterial line in hypertensive emergency?

An intra-arterial line is used for continuous blood pressure monitoring to ensure that blood pressure is reduced in a controlled and safe manner during hypertensive emergency treatment.

How does the treatment approach differ between hypertensive urgency and hypertensive emergency?

In hypertensive urgency, blood pressure is reduced slowly over days using oral medications to avoid sudden drops that could cause stroke. In hypertensive emergency, blood pressure is reduced more rapidly but still cautiously over hours, using intravenous medications, due to the presence of end-organ damage.