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Hypertension

Hypertension. Phone Call. Why is patient in hospital? Is patient pregnant (preeclampsia)? How high is BP and what has it been previously?. Phone Call. Does the patient have symptoms of hypertensive emergency? Chest/back pain: aortic dissection Chest pain: MI SOB: PE

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Hypertension

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  1. Hypertension

  2. Phone Call • Why is patient in hospital? • Is patient pregnant (preeclampsia)? • How high is BP and what has it been previously?

  3. Phone Call • Does the patient have symptoms of hypertensive emergency? • Chest/back pain: aortic dissection • Chest pain: MI • SOB: PE • Headache, neck stiffness: subarachnoid hemorrhage • HA, vomit, confusion, seizure: hypertensive encephalopathy • What antihypertensive has the patient been on?

  4. Thoughts • Benign • Hypertensive urgency: SBP>210 or DBP>120 with no end organ damage • Hypertensive emergency: end organ damage • Life threatening: • Eclampsia • Aortic dissection • Pulmonary edema • MI • Hypertensive encephalopathy

  5. Bedside Evaluation • Vitals • BP in both arms: if atherosclerosis artifactually low, aortic dissection • HR: tachycardia in catecholamine crisis, bradycardia in increased intracranial pressure • Symptoms of hypertensive emergency?

  6. Bedside Evaluation • HEENT: arteriolar narrowing, hemorrhages, papilledema • Lung: crackles, pleural effusions • CV: elevated JVP, S3 • Neuro: confusion, delirium, agitation, focal deficits

  7. Management • Essential hypertension: • In asymptomatic patient no acute lowering of BP needed • Hypertensive urgency: • Decrease MAP 25% in hours (can use PO meds) • Hypertensive emergency: • Call your senior-transfer pt to ICU/CCU • Decrease MAP 25% in minutes to 2 hours using IV agents

  8. Management IV Agents PO Agents *Cyanide toxicity-ms change,lactic acidosis, death

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