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Hypertensive Emergencies: Lakshmi Beeravolu, MD
Hypertensive Emergencies: Lakshmi Beeravolu, MD
EMERGENCIES
Lakshmi Beeravolu,MD
Discussion
Categories
Etiology/pathophysiology
History/Physical
Workup
Treatment
Case Scenarios
A 56 yo CM with no significant PMH presents to the ER
with headache,found to have BP 210/110mmHg and
papilledema.
An 82 yo male with h/o HTN,chronic renal insufficiency
presents for a routine physical,found to have BP of
230/130mmHg.
A 76 yo female is brought to the ER by the family due to
altered mental status.BP is 240/110 mmHg with no focal
neuro findings.
DEFINITIONS
Systolic blood pressure >220 and diastolic >120mmHg.
Patients with hypertension can be classified into 3 categories based upon their
symptoms and the organ systems that are affected at the time of presentation:
-HYPERTENSIVE EMERGENCY: also called hypertensive crisis, is severe
hypertension with acute impairment of an organ system (e.g., central nervous
system [CNS], cardiovascular, renal). In these conditions, the blood pressure (BP)
should be lowered aggressively over minutes to hours.Presence of papilledema
indicates MALIGNANT HYPERTENSION.
-HYPERTENSIVE URGENCY: the BP is a potential risk but has not yet caused acute
end-organ damage. These patients require BP control over several days to weeks.
-ACCELERATED HYPERTENSION: recent significant increase over baseline blood
pressure that is associated with target organ damage. This is usually vascular
damage on fundoscopic examination, such as flame-shaped hemorrhages or soft
exudates, but without papilledema.
ETIOLOGY
Essential hypertension : Inadequate blood pressure control and noncompliance are common
precipitants
Renovascular
Eclampsia/pre-eclampsia
Acute glomerulonephritis
Pheochromocytoma
Anti-hypertensive withdrawal syndromes
Head injuries and CNS trauma
Renin-secreting tumors
Drug-induced hypertension
Burns
Vasculitis
TTP
Idiopathic hypertension
Post-op hypertension
Coarctation of aorta
PATHOPHYSIOLOGY
NORMAL AUTOREGULATION
AUTOREGULATION FAILURE
RISE IN BP
RISE IN BP
FAILURE OF
VASOCONSTRICTION
ARTERIAL AND
ARTERIOLAR
CONSTRICTION
ENDOTHELIAL DAMAGE
(due to shear stress on the
wall)
Normal flow.(flow=P/r)
PATHOPHYSIOLOGY
BP=PVR*CO(SV*HR)
Rate at which MAP rises more important than absolute rise.