LOGO Hypertension Crisis M. Vejdanparast MD.Cardiologist
M.Vejdanparast
Introduction
Majority of patients presenting in ER with BP> 180 do not have a hypertensive emergencies or urgencies.
This patients can safely sent home with oral medication & arrangements made for F/U.
M.Vejdanparast
Definition
• Normal : <120/80
• Pre HTN: 120-139/80-89
• Stage I: 140-159/90-99
• Stage II: >160/100
• Severe HTN: 160/100 - 220/130
• Hypertensive urgency: >220/130 or Symptomatic HTN (without EOD)
• Hypertensive Emergency: HTN + EOD
M.Vejdanparast
Triage
Group 1 Group 2 Group 3
Symptoms Anxiety Asymptomatic
Headache Dyspnea Epistaxis
Sever headache Chest pain/Dyspnea Dysarthria
Examination No EOD Previous EOD New EOD
TreatmentDischarge or Observe 1-3h No therapy F/U>72h
Observe 3-6h Oral therapy F/U<24
IV therapy ICU admission
M.Vejdanparast
Severe HTN
Group 1
Symptom Anxiety Asymptomatic
Examination No EOD
Treatment Observe 1-3h No therapy F/U>72h
Hx of HTN
Yes No
Previous BP
ControlledUnControlled
New Case
Group 1
M.Vejdanparast
Urgent HTN
Drug Onset
Captopril 25mg 15-30min
Clonidine 0.1-0.2mg 30-60min
Inderal 40mg 20min
Frusemide 40mg 30min
Target Decreased 25% MAP ( 4-6h ) PO Medications
Group 2
M.Vejdanparast
Emergent HTN
Hypertensive crisis with retinopathy or acute renal insufficiency
Hypertensive encephalopathy
Acute aortic dissection
Acute pulmonary edema
Acute coronary syndrome
Acute ischemic stroke and BP >220/120 mm Hg
Acute ischemic stroke with indication for thrombolytic therapy and BP >185/110
Cerebral hemorrhage and SBP >180 mm Hg or MAP >130 mm Hg
Severe preeclampsia/eclampsia
Group 3
M.Vejdanparast
Emergent HTN
Contraindicated Nitroprusside Nitroglycerin Hydralazine
Emergent HTNGroup 3