HYPERTENSIVE CRISES (EMERGENCY AND URGENCY) TREATMENT, HYPERTENSIVE EMERGENCY MANAGEMENT ALOGRITHAM
Summary
TLDRThis 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
- π Hypertensive crisis is defined as a systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg.
- π¨ The presence of end-organ damage differentiates between hypertensive emergency and urgency; the former requires immediate treatment.
- π©Ί Signs of end-organ damage include myocardial infarction, unstable angina, acute renal failure, ischemic stroke, intracerebral hemorrhage, and hypertensive encephalopathy.
- π Hypertensive urgency is managed by controlled reduction of blood pressure over days to avoid the risk of stroke from sudden drops.
- π Oral medications, such as atenolol or long-acting calcium channel blockers, are typically used to treat hypertensive urgency.
- π₯ Hypertensive emergency mandates rapid but controlled blood pressure reduction within hours due to severe symptoms and organ damage.
- π©Ή In hypertensive emergency, intra-arterial lines are used for blood pressure monitoring and to ensure gradual reduction.
- π« 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.
- π Intravenous medications like labetalol and sodium nitroprusside are used for rapid blood pressure control in hypertensive emergencies.
- π² Do not use sublingual nifedipine for blood pressure reduction in hypertensive emergencies due to the risk of causing a stroke from rapid drops.
- π 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.
Outlines
π Hypertensive Crisis and Emergency Management
This paragraph discusses the critical nature of hypertensive crisis, characterized by a systolic blood pressure of over 180 mmHg or a diastolic blood pressure of over 120 mmHg. It distinguishes between hypertensive emergency and urgency based on the presence of end-organ damage. End-organ damage includes myocardial infarction, unstable angina, acute renal failure, stroke, intracerebral hemorrhage, and hypertensive encephalopathy. The management protocol for hypertensive emergency involves rapid blood pressure reduction within hours, with careful monitoring to avoid a greater than 25% drop in the first two hours. In contrast, hypertensive urgency is treated with oral medications over days to prevent the risk of stroke from sudden blood pressure drops. The paragraph emphasizes the importance of a gradual approach to avoid complications.
π Treatment Strategies for Hypertensive Urgency and Emergency
The second paragraph delves into the treatment strategies for hypertensive urgency and emergency. For urgency, where there is no end-organ damage, the approach is to reduce blood pressure gradually over days using oral medications like atenolol or calcium channel blockers. This method minimizes the risk of stroke due to sudden drops in blood pressure. In hypertensive emergency, where organ damage is evident, the focus shifts to reducing blood pressure more quickly, but still cautiously, within hours. Intravenous medications such as labetalol or sodium nitroprusside are used for rapid control. The paragraph warns against the use of sublingual nifedipine due to its potential to cause a dangerous rapid drop in blood pressure. The summary concludes with a reminder of the importance of proper management to prevent stroke and other complications in both hypertensive urgency and emergency.
Mindmap
Keywords
π‘Hypertensive Crisis
π‘End Organ Damage
π‘Hypertensive Emergency
π‘Hypertensive Urgency
π‘Myocardial Infarction
π‘Acute Renal Failure
π‘Ischemic Stroke
π‘Hypertensive Encephalopathy
π‘Pulmonary Edema
π‘Aortic Dissection
π‘Intravenous Medications
Highlights
Hypertensive crisis is defined as systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 120 mmHg.
Presence of end organ damage differentiates hypertensive emergency from hypertensive urgency.
End organ damage includes myocardial infarction, unstable angina, acute renal failure, ischemic stroke, intracerebral hemorrhage, and hypertensive encephalopathy.
Hypertensive urgency requires controlled reduction of blood pressure over days to avoid stroke.
Oral atenolol and long-acting calcium channel blockers are commonly used for managing hypertensive urgency.
Hypertensive emergency involves severe symptoms and organ damage, requiring rapid but controlled blood pressure reduction.
Intra-arterial line is used for blood pressure monitoring in hypertensive emergencies.
In hypertensive emergencies, blood pressure should be reduced by almost 25% in the first two hours.
Avoid decreasing blood pressure by more than 25% in the first two hours to reduce stroke risk.
In the next two to six hours, blood pressure should be reduced to a level of 160/200 in hypertensive emergencies.
IV labetalol and sodium nitroprusside are used for rapid blood pressure reduction in hypertensive emergencies.
Sublingual nifedipine should not be used due to its potential to cause a rapid drop in blood pressure and stroke.
Hypertensive urgency is managed with oral drugs and a gradual reduction of blood pressure over days.
Hypertensive emergency requires a more rapid but still controlled reduction of blood pressure over hours.
Even in hypertensive emergencies, blood pressure should be reduced slowly to minimize the risk of stroke.
The treatment approach for hypertensive crisis depends on the presence or absence of end organ damage.
Monitoring and managing blood pressure in hypertensive emergencies is crucial to prevent further organ damage.
Transcripts
okay so in our video series on
step-by-step hypertension treatment in
this video we'll be talking about
hypertensive crisis hypertensive crisis
are defined as systolic blood pressure
greater than
180 mm of energy or diastolic blood
pressure greater than 120
mm of hg that is called as hypertensive
crisis
now the next thing that you have to see
if the patient has blood pressure like
this
that whether there is end organ damage
present or not
if the end organ damage is present that
is called as hypertensive
emergency and it has a different
management protocol
then when the end organ damage is absent
in
when the end organ damage is absent it
is called as hypertensive urgency
what counts as an end organ damage if
the patient develops myocardial
infarction if the patient is having
unstable angina as evident on ecg are
cardiac markers
that is an organ damage it means that
the organs are being affected by this
high blood pressure
if the patient is developing acute renal
failure if you see elevated threatening
deranged rfts
if the patient develops ischemic stroke
if the patient is having intracerebral
hemorrhage
or if the patient is developing symptoms
of hypertensive encephalopathy like
headache confusion
altered mental status it means that the
organs are being damaged
that is hypertensive emergency and
hypertensive emergency must be treated
as quickly as possible or if the patient
has pulmonary edema or aortic dissection
that counts as end organ damage you see
that on chest x-ray
so if the end organ damage is present
that is hypertensive
emergency so if the end organ damage is
present that is hypertensive
emergency if and organ damage is absent
that is hypertensive
urgency now what is the treatment of
hypertensive urgency hypertensive
urgency the aim is controlled reduction
of blood pressure
in urgency we reduce blood pressure over
days
not in ours so we slowly bring back the
blood pressure to a normal range we do
not quickly drop the blood pressure
why do we not quickly drop the blood
pressure why
is it treated over days not in us
because
sudden drop in blood pressure can cause
stroke
so to avoid stroke we reduce the blood
pressure
slowly over days now how do you reduce
the blood pressure of the patient you
advise
bed rest and you there is no ideal
hypotensive agents used for it but
mostly we use
oral atenolol and or a long-acting
calcium channel blocker oral drugs are
being used
to bring back the blood pressure slowly
to a normal range that is the treatment
of hypertensive
urgency hypertensive emergency has a
different
management hypertensive emergency
patient is developing and organ damage
patient is having focal cns symptoms
seizures coma
in the presence of this and organ damage
you have to reduce blood pressure
in hours rather than days you insert an
intra arterial line for bp monitoring
and you reduce the diastolic blood
pressure to almost one then over four
hours
so in hypertensive urgency we were
reducing blood pressure in days
because the patient was not having
severe symptoms severe and organ damage
in hypertensive emergency we are
reducing blood pressure in hours but
in even in hypertensive emergency we do
not drop
blood pressure very rapidly what we do
is that we avoid decreasing blood
pressure to greater than 25 percent in
the first two hours
almost 25 percent blood pressure is
decreased in the first two hours
and in the next two to six hours you
bring the blood pressure to level of 160
200
and then you slowly gradually bring back
bring it back to the normal range
so even in hypertensive emergency we are
bringing the blood pressure to normal
ranges within hours
but we bring it back slowly and
gradually we are not doing going very
quick because it
increases the risk of stroke
you either give iv lebron 50 milligram
iv over one minute and you repeat
it every five minute till you reach a
maximum dose of 200 milligram
or you give sodium nitro procite
infusion
to control the blood pressure in
hypertensive emergency
if you see we are giving these drugs iv
rather than oral
for a rapid reduction of blood pressure
in
ours one very important thing is that
you never use sublingual nephadi pain to
reduce blood pressure because
it causes a rapid drop in blood pressure
and it can even cause
stroke in summary systolic pressure
greater than 180 mm of energy and
diastolic pressure greater than 120 mm
of energy
is hypertensive crisis if and organ
damage is present hypertensive emergency
if the endogen damage is absent
hypertensive urgency
this is all and organ damage if the
patient is having mi
renal failure stroke hypertensive
encephalopathy and all this
hypertensive urgency needs to be treated
with oral drugs and you reduce the blood
pressure
over days not in hours because sudden
drop in blood pressure can
precipitate stroke hypertensive
emergency patient is already having and
organ damage you reduce the blood
pressure in hours
not in days but even in hours you go in
a slow fashion what you do
is that you reduce blood pressure to
almost 1 10 over 4 hours and then you
bring the blood pressure to a range of
160 by 100 in the next two to six
hours and and then you bring the blood
pressure back to normal ranges
after some time so even in hypertensive
emergency you are going
slow to reduce the risk of stroke you
give
iv drugs i will a bitter lol and nitro
procyte
never use sublingual nephritic pain
because it causes rapid drop in blood
pressure and can cause
stroke so this was all about
hypertensive prices if you liked my
video please
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hypertension treatment
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