hypertensive emergencies and secondary ht
TRANSCRIPT
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Secondary Hypertension and Hypertensive Emergencies.Diagnostic Evaluation and
Treatment
Dr Lázaro N Rodríguez González
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Classification of Blood Pressure for Adults Aged 18 Years and Older
• Normal BP = Systolic BP <120mmHg + Diastolic BP <80mmHg
• PreHt = Syst BP 120 – 139mmHg or Diast BP 80 – 89mmHg
• Stage 1 Ht = Syst BP140 – 159mmHg or Dist BP 90 – 99mmHg
• Stage 2 Ht = Syst BP 160mmHg or Diast BP 100mmHg
(JNC VII.2003)
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Johnson et al. Cardiol Clin 30 (2012) 533–543
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Clinical Evaluation
History Medication
Drugs (meth-amphetamine, Cocaine)
Detailed physical examination looking forpresence of end-organ damageCV examNeurological examination Fundoscopy (Exudates, Hemorrhages, Papilledema)
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Investigations
• LAB TESTS U&E, Cr, FBC, cardiac markers
• URINEProtein, urea and casts
• ECGLook for LVH, Myocardial Infarction/Ischemia
• CXRLook at cardiothoracic index/pulmonary edema/widened mediastinum
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HT ENCEPHALOPATHY
• Acute organic brain syndrome in the setting of severe hypertension
• Clinical manifestations of cerebral oedema and micro-haemorrhages seen with dysfunction of cerebral autoregulation
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HT ENCEPHALOPATHY
• SymptomsSevere headache Nausea VomitingVisual disturbances Confusion Weakness
SignsDisorientation Focal neurologic defectsNystagmus Focal or generalized seizures
If not properly treated it can lead to cerebral bleeding/infarction, coma and death
With proper treatment, however, it is completely reversible
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Summary
• Acute end-organ damage Treat in ICU/HCUWith IV medicationTo achieve prompt but gradual reduction in BP
Lower mean arterial pressure by ± 25% or reduce diast BP to100-110mmHg
NB Be careful not to drop intravasc volume too rapidly cardiac or cerebrovascular hypoperfusion
Management of Ht emergencies should be individualized and should be specific to end-organ at risk
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THE END