Overview
This lecture discusses hypertensive crisis, distinguishing between hypertensive urgency and emergency, their causes, symptoms, diagnostic approaches, and treatments.
Definition and Classification
- Hypertensive crisis is acute, severe hypertension with systolic BP >180 mmHg and/or diastolic BP >120 mmHg.
- It is divided into hypertensive urgency (no organ damage) and hypertensive emergency (evidence of organ damage).
Causes of Hypertensive Crisis
- Most common cause: non-adherence to antihypertensive medications.
- Other causes include pregnancy (pre-eclampsia), kidney (renal) disorders, certain medications (e.g., NSAIDs), and drugs (e.g., cocaine).
Symptoms and Clinical Presentation
- Hypertensive urgency: headaches, nosebleeds, dizziness, restlessness, insomnia, but no organ damage.
- Hypertensive emergency: altered mental status, vision changes, signs of heart failure or myocardial infarction, kidney failure (back pain), abdominal pain (possible aortic aneurysm).
Diagnosis and Assessment
- Assess vital signs and confirm high BP (≥180/120 mmHg).
- Conduct ECG/EKG to check heart rhythm and function.
- Obtain chest X-ray to assess heart and lung condition.
- Perform CT head imaging if neurological symptoms are present.
- Order lab tests: CBC, CMP/BMP, cardiac enzymes (troponin, BNP), and urinalysis for kidney function.
Treatment Principles
- For urgency, give prescribed antihypertensive medication (often IV) and monitor response.
- For emergency, initiate IV antihypertensives and monitor closely, aiming for BP reduction by ~25% in the first hour.
- Avoid rapid BP lowering to prevent reduced organ perfusion.
- Identify and address underlying causes (medication non-adherence, organ dysfunction).
- Patients with emergencies often require ICU admission and intensive monitoring (telemetry, frequent vital signs, neurological checks, strict intake/output).
Key Terms & Definitions
- Hypertensive crisis — Severely elevated blood pressure with risk or presence of organ damage.
- Hypertensive urgency — High BP without acute organ damage.
- Hypertensive emergency — High BP with signs of acute organ damage (brain, heart, kidneys, etc.).
- Organ damage — Injury to body organs (e.g., heart, brain, kidneys) resulting from high BP.
- Telemetry — Continuous heart monitoring.
- CMP/BMP — Blood tests to assess metabolic and kidney function.
Action Items / Next Steps
- Review causes, symptoms, and management of hypertensive crisis.
- Study distinguishing features of urgency vs. emergency.
- Practice interpreting BP values and relevant patient scenarios.
- Prepare for questions on treatment goals and diagnostic work-up.