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Hypertensive Emergency and Urgency

This document discusses hypertensive emergencies and urgencies. It defines a hypertensive emergency as an acute, severe elevation in blood pressure associated with target organ damage, while a hypertensive urgency is an acute elevation in blood pressure above 180/120 mmHg without target organ damage. The primary causes of hypertensive emergencies are listed as renovascular disease, pheochromocytoma, non-adherence to medications, hyperaldosteronism, and erythropoietin. Clinical features, history, examination findings, and investigations for hypertensive emergencies are outlined. Hypertensive urgency can be managed with oral drugs while labetalol and clonidine are useful for immediate

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151 views12 pages

Hypertensive Emergency and Urgency

This document discusses hypertensive emergencies and urgencies. It defines a hypertensive emergency as an acute, severe elevation in blood pressure associated with target organ damage, while a hypertensive urgency is an acute elevation in blood pressure above 180/120 mmHg without target organ damage. The primary causes of hypertensive emergencies are listed as renovascular disease, pheochromocytoma, non-adherence to medications, hyperaldosteronism, and erythropoietin. Clinical features, history, examination findings, and investigations for hypertensive emergencies are outlined. Hypertensive urgency can be managed with oral drugs while labetalol and clonidine are useful for immediate

Uploaded by

harshini
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Hypertensive emergency and

urgency- evaluation
- Vennmadhi Vallentina . D
Hypertensive emergency
• Hypertensive emergency is acute, severe elevation in blood pressure
associated with target organ damage.

• Patients with hypertensive emergency usually present with a systolic BP of


>180 mmHg and/or diastolic BP of >120 mmHg, though there is no
specific threshold since individuals who develop an acute rise in blood
pressure (even if less than 180/120) can develop target organ damage if the
previous pressure was normal.

• Earlier terms - malignant hypertension and accelerated hypertension


What is the primary reason for hypertensive
emergencies ?

1. Renovascular Disease
2. Pheochromocytoma
3. Non-adherence to anti-hypertensive medication
4. Hyperaldosteronism
5. Erythropoeitin
Clinical features

• Damage is rapidly progressive and often


fatal.
• The characteristic vascular lesion is
fibrinoid necrosis of arterioles and small
arteries, which causes the clinical
manifestations of end organ damage.
Symptoms
History
o History of hypertension

• Duration and patient baseline

• Controlled or Uncontrolled

• Compliant or Non-compliant

• High BP readings

o Co-morbidities

o Evidence of any target-organ damage

o Details of current antihypertensive therapy

o Recreational drug use


EXAMINATION FINDINGS
• 02 Saturation

• Cardiovascular svstem

✓ Check patients blood pressure in both arms

✓ Elevated JVP

✓ Heart murmur- ischemic mitral regurgitation

✓ Basal lung crepitations

• Central Nervous System

✓ Altered mental status

✓ Focal neurological deficits

• Abdomen

✓ Palpate abdominal masses

✓ Auscultate for renal bruits

• Fundoscopic Examination
Investigation
• Urinalysis with microscopy
✓ Dymsorphic red cells
✓ Pigmented granular casts
✓ Absence of blood or protein make glomerular disease less likely?
• Complete blood count
• Electrolyte, urea, creatinine, glucose
✓ - Low potassium think of hyperaldosteronism
• ECG
✓ Signs of strain
✓ LVH
• CXR
✓ Signs of heart failure
• Doppler US to look for renal artery stenosis
Hypertensive urgency
• Hypertensive urgency is acute, severe elevation in blood
pressure to >180/120 mmHg without evidence of target organ
damage.

• Thus, the main difference between hypertensive emergency and


urgency is -

✓ the presence of target organ damage (hypertensive emergency)

✓ absence of target organ damage (hypertensive urgency)

• Hypertensive urgency can be managed by oral drugs.

• For immediate reduction of BP and hypertensive urgency,


labetalol and clonidine are useful.
Thank you

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