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10/17/23, 4:07 PM Realizeit for Student Hypertensive Crises Two classes of hypertensive crisis that require immediate intervention include hypertensive emergency and hypertensive urgency, which occur when the SBP exceeds 180 mm Hg or the DBP exceeds 120 mm Hg. Hypertensive emergencies and urgencie...

10/17/23, 4:07 PM Realizeit for Student Hypertensive Crises Two classes of hypertensive crisis that require immediate intervention include hypertensive emergency and hypertensive urgency, which occur when the SBP exceeds 180 mm Hg or the DBP exceeds 120 mm Hg. Hypertensive emergencies and urgencies may occur in patients with secondary hypertension, and in those whose hypertension has been poorly controlled, whose hypertension has been undiagnosed, or in those who have abruptly discontinued their medications (i.e., rebound hypertension). Once the hypertensive crisis has been managed, a complete evaluation is performed to review the patient’s ongoing treatment plan, and strategies to prevent the occurrence of subsequent hypertensive crises are implemented (Whelton et al., 2017). Hypertensive emergency is severe BP elevation (SBP greater than 180 mm Hg or DBP greater than 120 mm Hg) with new or worsening target organ damage. Some examples of target organ damage that may occur include hypertensive encephalopathy, ischemic stroke, MI, heart failure with pulmonary edema, dissecting aortic aneurysm, and renal failure. The 1-year mortality rate is more than 79% and median survival is 10.4 months if left untreated (Whelton et al., 2017). The patient needs to be admitted to the intensive care unit for continuous monitoring of BP and parenteral administration of an appropriate antihypertensive medication (Whelton et al., 2017). A rapid and focused assessment is necessary to determine possible causes and target organ involvement. For patients with suspected aortic dissection, the management goal is to reduce the SBP to less than 120 mm Hg within the first hour of treatment (Fukui, 2018; Whelton et al., 2017). For those patients with suspected severe preeclampsia/eclampsia or pheochromocytoma crises, the management goal is to reduce the SBP to less than 140 mm Hg within the first hour of treatment (Lim, 2018; Whelton et al., 2017). The treatment management goal for other patients with hypertensive emergencies is to reduce the SBP by no more than 25% within the first hour of treatment, and then, if the patient is stable, to 160/100 mm Hg within the next 2 to 6 hours with an eventual goal of a normal, controlled blood pressure within 24 to 48 hours of when treatment commenced (Whelton et al., 2017). The antihypertensive medications of choice are those that have immediate onsets of action, and can include intravenous drugs such as nicardipine, clevidipine, labetalol, esmolol, nitroglycerin, and nitroprusside (Whelton et al., 2017). To date, there is a dearth of research findings that demonstrate the superiority of any antihypertensive medications in treating hypertensive emergencies (Whelton et al., 2017). Hypertensive urgency is severe BP elevation (SBP greater than 180 mm Hg or DBP greater than 120 mm Hg) in stable patients without target organ damage as evidenced based on clinical examination and results of laboratory studies. Many times, patients with a hypertensive urgency are nonadherent with antihypertensive therapy, resulting in rebound hypertension. The underlying reason for nonadherence should be explored (e.g., finances, anxiety, misunderstandings, miscommunication, https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IWsgl87YCND5MlxcaDR%2bIXwVK92JaTnVop0r%2bp7eT… 1/2 10/17/23, 4:07 PM Realizeit for Student drug side effects, or recreational drug use) and the team approach used and resources mobilized to prevent nonadherence from continuing or recurring. Restarting antihypertensive medication therapy or increasing dosages are indicated in treating these patients (Whelton et al., 2017). Extremely close monitoring of the patient’s blood pressure and cardiovascular status is required during treatment of hypertensive emergencies and urgencies. The exact frequency of monitoring is a matter of clinical judgment and varies with the patient’s condition. Taking vital signs every 5 minutes is appropriate if the blood pressure is changing rapidly; taking vital signs at 15- or 30-minute intervals in a more stable situation may be sufficient. A precipitous drop in blood pressure can occur that would require immediate action to restore blood pressure to an acceptable level. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IWsgl87YCND5MlxcaDR%2bIXwVK92JaTnVop0r%2bp7eT… 2/2