Hypertensive Crisis

Hypertensive Crisis

• SBP >180 mmHg and/or DBP >120 mmHg

Hypertensive Emergency

• Requires hospitalization due to target organ damage
• Can result in severe problems if not promptly recognized and treated
• Associated with:
  • Encephalopathy
  • Intracranial or subarachnoid hemorrhage
  • Heart failure (HF)
  • Myocardial infarction (MI)
  • Renal failure
  • Dissecting aortic aneurysm
  • Retinopathy
• Untreated, mortality rate is 79% in one year

Hypertensive Urgency

• More common than hypertensive emergency
• No evidence of target organ disease
• Hospitalization usually not required
• Associated with chronic stable disorders:
  • Stable angina
  • Chronic HF
  • Prior MI or CVA

Causes of Hypertensive Crisis

• History of HTN; non-adherence or undermedication
• Use of substances:
  • Cocaine
  • Amphetamines
  • PCP
  • LSD
• Leading to seizures, stroke, MI, or encephalopathy

Clinical Manifestations

• Hypertensive encephalopathy:
  • Altered mental status
  • Headache
  • Nausea/vomiting
  • Seizures
  • Confusion
  • Coma
  • Retinal changes
• Renal insufficiency
• Cardiac decompensation:
  • MI
  • HF
  • Pulmonary edema
  • Chest pain
  • Dyspnea
• Aortic dissection:
  • Chest and back pain
  • Reduced/absent peripheral pulses

Nursing and Interprofessional Care

• Hospitalization for HTN emergency
• Treatment focused on BP and evidence of target organ disease
• IV drugs:
  • Slow titration
  • MAP 110 to 115 mmHg
  • MAP = (SBP +2 DBP) ÷ 3
• Drugs:
  • Vasodilators (e.g., sodium nitroprusside)
  • Adrenergic inhibitors
  • Calcium channel blockers
• Monitoring:
  • HR and BP q. 2 to 3 minutes
  • Cardiac and renal function
  • Neurological checks
• Bed rest for those on IV drugs
• Determine cause of crisis
• Education to avoid future crisis

Hypertensive Urgency: Outpatient Care

• Common oral meds:
  • Captopril
  • Labetalol
  • Clonidine
  • Amlodipine
• Require follow-up, often within 24 hours

This quiz covers the definition, symptoms, and consequences of hypertensive crisis, including hypertensive emergency and hypertensive urgency, and the importance of prompt recognition and treatment.