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What is a hypertensive urgency?
hypertensive crisis with no acute target organ damage
What is a hypertensive emergency?
hypertensive crisis with acute target organ damage
What are the risk factors for hypertensive crisis?
- african american
- usually have previous HTN dx
- cocaine use
- hx of stroke
- hx of CHF
What are the clinical sx of HTN emergency?
- hypertensive encephalopathy
- acute MI/ACS
- pulmonary edema (acute CHF)
- aortic dissection
- acute kidney injury
What are the clinical sx of HTN urgency?
How do you do an initial evaluation for HTN crisis?
- new sx
- med hx
- physical exam
- quickly assess and implement plan
How do you treat HTN urgency?
- slow BP reduction (24-48h)
- add new anti-HTN and/or
- increasing dose of current med or
- acute short-acting oral anti-HTN
- 1-3d follow-up in office
What drugs are used for HTN urgency?
- captopril (or other ACEI)
How do you treat HTN emergency?
- immediate BP reduction:
- 10-15% DBP reduction or to about 110 mmHg (in 30-60 min)
- if stable, bring to 160/100-110 (2-6h)
- if tolerated, further reduce BP (24-48h)
What drugs are used for HTN emergency?
What drugs should be avoided in HTN emergency?
What is the DOC for HTN crisis with acute MI/ACS?
labetalol or esmolol w/ nitro
What is the DOC for HTN crisis with pre-eclampsia/eclampsia?
labetalol or nicardipine
What is the DOC for HTN crisis with ARF/microangiopathic anemia?
nicardipine or fenoldopam
What is the DOC for HTN crisis with sympathetic crisis/cocaine overdose?
- diazepam or lorazepam
- phentolamine and nitro (second line)
What is the DOC for HTN crisis with acute postoperative HTN?
esmolol, nicardipine, or labetalol
What drug is CI in glaucoma?
What drug is CI in acute CHF, asthma or low HR?
What drug is CI in acute CHF or coronary ischemia?
What drug is CI in renal failure +dehydration or hyperkalemia?