Hypertensive Emergencies



Hypertensive Emergencies


Savithiri Ratnapalan



Introduction



  • High-normal blood pressure (BP): 90-95th percentile


  • Moderate hypertension: 95-99th percentile


  • Severe hypertension: persistently at or above 99%


  • Hypertensive urgency: elevated BP without end-organ damage


  • Hypertensive emergency: elevated BP with evidence of end-organ damage


Risk Factors for Hypertension



  • Prematurity, low birth weight, or other neonatal complications


  • Congenital heart disease


  • Certain urinary or kidney problems


  • Organ or bone marrow transplant


  • Treatment with medications known to raise blood pressure


  • Illnesses associated with high blood pressure, such as neurofibromatosis








Table 32.1 Causes of Hypertension















Newborns

Renal artery thrombosis, renal artery stenosis, congenital renal malformation, coarctation of the aorta, bronchopulmonary dysplasia


Infancy to 6 years

Renal parenchymal disease, coarctation of the aorta, renal artery stenosis


6-10 years

Essential hypertension (including obesity), renal artery stenosis, and renal parenchymal diseases


Adolescence

Essential hypertension (including obesity), renal parenchymal diseases




History



  • Neurologic symptoms: headaches, vomiting, irritability, seizures, features of encephalopathy


  • Renal symptoms: decreased urine output, edema


  • Endocrine symptoms: sweating, flushing, palpitations, fever, weight loss


  • Past history: UTI, fever, hematuria, dysuria, edema, umbilical artery catheterization


  • Medications including birth control pill, toxins, illicit drugs


  • Family history: renal disease, hypertension, stroke


Physical Exam



  • Growth


  • Evidence of congestive heart failure (tachypnea, hepatomegaly)


  • Femoral pulses, four limb blood pressures


  • Thyroid


  • Neurologic exam and fundoscopy (papilledema, hemorrhage, edema, infarcts)


  • Abdominal bruit, abdominal masses


Investigations


















Basic:

CBC, urea, creatinine, ESR, electrolytes, calcium, uric acid, lipid profile

Urinalysis, microscopy, culture

ECG, CXR


Consider:

Renal ultrasound, echocardiogram

Urinary catecholamines and toxicology screen

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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Hypertensive Emergencies

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