Hypertensive Emergencies

Question 1

Medications used for HTN Urgency

Answer 1

Clonidine
Labetolol
Captopril

Question 2

Screening for End Organ Damange

Answer 2

ECG
UA: proteinuria, casts, & RBCs
Creatinine/GFR
Potassium/glucose
Hematocrit

Question 3

Disposition for HTN Urgency

Answer 3

Discharge with 24-48 hrs f/u with PCP

Question 4

HTN Urgency

Answer 4

severe increase of BP (DBP>115) WITHOUT evidence of target organ damage (TOD)

Question 5

HTN Emergency/ Malignant HTN

Answer 5

severely elevated blood pressure (usually >180/110) WITH end organ damage or dysfunction

Question 6

Neurologic S/Sx’s of HTN emergency

Answer 6

HA, N/V, diplopia, blurred vision, confusion, hemiparesis, seizures

Question 7

Cardiac s/sx’s of HTN emergency

Answer 7

Chest pain, dyspnea, tachycardia, pulmonary edema, palpitations

Question 8

Renal S/Sx’s of HTN emergency

Answer 8

Hematuria, oliguria, anuria or edema

Question 9

PE for HTN emergency

Answer 9

BP
CV exam: focus for HEART FAILURE
Neuro: LOC, focal neurologic signs
Fundoscopy

Question 10

Diagnostics for HTN emergency

Answer 10

EKG: look for ischemia or LVH
CXR: check for CHF, aortic dissection
CT Head: CVA or hemorrhage

Question 11

Tx goal for HTN emergency

Answer 11

reduce MAP by 25% within 1 hour

Question 12

Conditions Defining Hypertensive Emergency

Answer 12

HYPERTENSIVE ENCEPHALOPATHY
Stroke Syndrome
Catecholamine Induced (Cocaine & Pheochromocytoma)
Left ventricular failure/Acute Pulmonary Edema
Acute Coronary Syndrome
Aortic Dissection
Acute Renal Failure
GESTATIONAL HTN & PREECLAMPSIA

Question 13

Most common clinical presentations of hypertensive emergencies

Answer 13

Cerebral infarction (24.5%)
Pulmonary edema (22.5%) 
Hypertensive encephalopathy (16.3%)
Congestive heart failure (12%)

Question 14

Hypertensive encephalopathy findings

Answer 14

Usually acute in onset & reversible
Neurologic symptoms:
H/A, nausea/vomiting, confusion, or coma.
PE findings:
Papilledema
Neurologic deficits that do not fit a stroke pattern

Question 15

Management of Hypertensive Encephalopathy

Answer 15

1. Immediate IV drug therapy
2. Start therapy FIRST, then CT head
3. Admission to ICU

Question 16

Medication of choice for HTN Emergencies

Answer 16

Sodium nitroprusside (Nipride)

Question 17

Medications for HTN Emergencies

Answer 17

Sodium nitroprusside (Nipride)
Labetalol
Hydralazine
Enalapril
Fenoldopam

Question 18

first line med for preeclampsia/pregnancy induced HTN

Answer 18

Hydralazine

Question 19

HTN emergency med uceful in CHF or CVA pts

Answer 19

Enalapril

Question 20

HTN emergency med useful in renal dz

Answer 20

Fenoldopam

Question 21

severe pre-eclampsia key features

Answer 21

BP > 160/110 typically
New onset proteinuria/ ↑creatnine
Elevated LFT’s/ low platelets common (HELLP)
H/A, visual changes, abd. pain, pulmonary edema & hyper-reflexia

Question 22

Management of Gestational HTN

Answer 22

1. Seizure prophylaxsis: 4-6 Gram IV Magnesium Sulfate
2. IV Hydralazine 10 mg IV or Labetolol 20 mg IV.
3. Early OB involvement/admission

Question 23

Disposition of Hypertensive Emergency

Answer 23

Hospitalize all!