Hypertensive crisis





This chapter will review the pharmacotherapy for treatment of high blood pressure according to the 2017 High Blood Pressure Clinical Practice Guideline.


Definitions


Hypertensive urgency


Severe elevations in blood pressure (>180/120 mm Hg) without target organ damage.


Hypertensive emergency


Severe elevations in blood pressure (>180/120 mm Hg) with target organ dysfunction (e.g., chest pain, vision changes, acute kidney injury, aortic dissection, acute shortness of breath, heart failure exacerbation, obtundation).


Management





  • Hypertensive crisis ( Fig. 5.1 )




    Figure 5.1


    Diagnosis and Management of Hypertensive Crisis.

    From Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248 . BP , blood pressure; Class I , Strong recommendation; DBP , Diastolic blood pressure; ICU , Intensive care unit; SBP , Systolic blood pressure. *Use medication specified in Table 5.1 . If other comorbidities present, select a medication specified in Table 5.1 .



  • Hypertension in acute intracerebral hemorrhage ( Fig. 5.2 )




    Figure 5.2


    Management of Hypertension in Acute Intracerebral Hemorrhage (ICH).

    From Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248 . BP , Blood pressure; Class IIa , Can be beneficial; Class III , No benefit; IV , intravenous; SBP , systolic blood pressure.



  • Hypertension in acute ischemic stroke ( Fig. 5.3 )




    Figure 5.3


    Management of Hypertension in Acute Ischemic Stroke.

    From Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248 . BP , Blood pressure; Class I , Strong recommendation; Class IIa , Moderate recommendation (can be beneficial); Class IIb , Weak recommendation; Class III , No benefit; DBP , Diastolic blood pressure; IV , intravenous; SBP , systolic blood pressure.

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Feb 28, 2021 | Posted by in EMERGENCY MEDICINE | Comments Off on Hypertensive crisis
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