PHRD6085 Pharmacotherapy Lecture 6 - Hypertensive Crisis

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criteria for hypertensive urgency
- BP 180/110 mmHg
- NO end organ damage
criteria for hypertensive emergency
- BP 180/110 mmHg
- End organ damage
2 equations for MAP
- (CO*SVR) + CVP
- (2*DBP + SBP)/3
list common causes of hypertensive crises
- lack of adherence to antihypertensive meds
- abrupt inc in BP in pts w/ chronic HTN
- sympathomimetic drugs
- w/drawal from antihypertensive agents
- preeclampsia
- head injury
- acute glomerulonephritis
- vasculitis
list types of end organ damage assoc'd w/ HTN emergency
- cerebral infarction
- acute pulmonary edema
- hypertensive encephalopathy
- acute congestive HF
- acute MI or unstable angina
HTN Urgency goals of tx
- reduce BP to 160/100 mmHg over several hours-days
- avoid reduction in MAP >25% in first 24hr
- LT BP goal = <140/90 mmHg
HTN Urgency treatment
- gradual reduction of BP w/ PO meds
- no hospitalization
- monitor w/in 7 days
- *AVOID rapid release nifedipine
list drugs used in HTN urgency (5)
- labetalol (200mg po, q3-4hr)
- captopril
- clonidine
- nicardipine
- minoxidil
HTN emergency goals of tx
- decrease BP by 10% during first hour, then 15% over next 2-3hr
- get BP to 160/100 mmHg over first 6hr
- avoid reducing MAP >25% during first 2hr
- LT BP goal = <140/99mmHg
goal values for aortic dissection & HTN emergency
- SBP <120mmHg
- MAP < 80mmHg
- WITHIN 10 MINUTES
list drugs used in HTN emergency (9)
- labetalol (2mg/min IV or 20-80mg q10min up to 300mg)
- nicardipine (5mg/hr IV then titrate 2.5mg/hr q5min to desired BP - max 15mg/hr)
- nitroglycerin
- nitroprusside
- hydralazine
- clevidipine
- enalaprilat
- esmolol
- fenoldopam
what may occur if there is too rapid of a MAP reduction?

cerebral hypoperfusion
treatment option for HTN emergency + aortic dissection

labetalol 2mg/min IV
treatment option for HTN emergency + angina/MI

labetalol 2mg/min IV
treatment option for acute pulmonary edema/left ventricular failure

nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
treatment option for HTN emergency + acute renal failure

nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
treatment option for HTN emergency + cocaine OD/sympathetic crisis

nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to desired BP
treatment option for HTN emergency + pheochromocytoma

nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP
treatment option for HTN emergency + hypertensive encephalopathy/intracranial hemorrhage/subarachnoid hemorrhage/thrombotic stroke

nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP
treatment option for HTN emergency + pre-eclampsia/eclampsia

nicardipine 5mg/hr IV then titrate 2.5mg/hr q5min to goal BP

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PHRD6085 Pharmacotherapy Lecture 6 - Hypertensive Crisis

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Hypertensive Crisis

Updated

9/5/2014, 8:38:20 AM

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