Complicated Hypertension Flashcards
Malignant Hypertension
> _180/>_100
Rate of Increase of BP is more important than #
Hypertensive Urgency
Elevated Blood Pressure
Hypertensive Emergency
Elevated Blood Pressure w/ end organ damage
Organ Damage in HTN Emergency
Eyes: retinal hemorrhage Brain: CVA, seizure, encephalopathy Heart: MI, CHF, aortic Discection Lungs: Edema from CHF Kidneys: acute renal failure
Malignant HTN associated w/?
Diffuse Necrotizing Vasculitis
Arteriolar Thrombi
Fibrin Deposition in the arteriolar wall
Fibrin Necrosis of the arterioles of the brain, retina, kidney
Signs and Symptoms
Brain
Eyes
Kidney
encephalopathy
hemorrhage, papilledema, retinopathy
proteinuria, renal failure
Guidelines for Lowering BP
No more than 25% reduction in MAP in first 2 hours
OR
160/100-110
Malignant HTN Meds
BB Labetalol (Trandate) IV B1&A1 blockade can give small repeat doses doubling each time 20mg, 40, 80, 160 CCB Nicardipine (Cardene) IV
Hypertensive Mgmt in ? Emergencies
Hypertensive Encephalopathy Stroke MI Aortic Discection Eclampsia
HTN Encephalopathy meds
Same for stroke
Labetalol (Trandate) BB
Nicardipine (Cardene) CCB
Nitroprusside (Nitropress) SE cyanide tox, drug is photosensitive
Stroke meds
Same for HTN Encephalopathy
Labetalol (Trandate) BB
Nicardipine (Cardene) CCB
Nitroprusside (Nitropress) SE cyanide tox, drug is photosensitive
MI meds
Nitroglycerine (Nitrostat) SE hypotension, headache
Labetalol (Trandate) BB
Nicardipine (Cardene) CCB
Aortic Dissection goal & meds
Goals: #1 control shearing forces by reducing rate and contractility= BB or Labetalol (Trandate) #2 tightly control HTN = Nitroprusside (Nitropress)
Preeclampsia/Eclampsia meds
Hydralazine
Labetalol
Nicardipine
Magnesium (not for BP)
Hydralazine
Arterial Vasodilator
SE= rebound HTN
Pre/Eclampsia
