{"id":9638,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/hypertensive-emergencies-and-urgencies\/"},"modified":"2022-01-04T18:16:36","modified_gmt":"2022-01-04T16:16:36","slug":"hypertensive-emergencies-and-urgencies","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/hypertensive-emergencies-and-urgencies\/","title":{"rendered":"Hypertensive emergencies and urgencies"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Hypertensive emergencies and urgencies are grouped as <strong>hypertensive crises<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Hypertensive urgency<\/strong> is defined as severe hypertension (&gt;180\/120 BP)<\/li><li><strong>Hypertensive emergency<\/strong> is defined as severe hypertension with end-organ damage (stroke, acute heart failure, aortic dissection)<\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Causes<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Renal or renovascular disease<ul><li>Renal artery stenosis<\/li><li>Nephritic syndrome<\/li><\/ul><\/li><li>Eclampsia\/pre-eclampsia<\/li><li>Vasculitis<\/li><li>Endocrine<ul><li>Hyperaldosteronism<\/li><\/ul><ul><li>Cushing&#8217;s disease and syndrome<\/li><li>Pheochromocytoma<\/li><li>Acromegaly<\/li><li>Thyrotoxicosis<\/li><li>Hyperparathytroidism<\/li><\/ul><\/li><li>Drugs\/medications<ul><li>Cocaine<\/li><li>Methamphetamine<\/li><li>Sudden cessation of beta-blockers or clondine<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Presentation of hypertensive emergency<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Eyes &amp; brain<ul><li>Retinopathy\/papilledema<\/li><li>Posterior reversible encephalopathy syndrome<\/li><li>Hemorrhage\/stroke<\/li><\/ul><\/li><li>Heart &amp; lungs<ul><li>MI<\/li><li>Aortic dissection<\/li><li>Pulmonary edema<\/li><\/ul><\/li><li>Renal system<ul><li>Nephrosclerosis<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Diagnosis and evaluation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">As the only difference between the two is the presence of organ damage, it is important to rule it out or diagnose it in case it exists:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Blood panels and cardiac markers<\/strong><\/li><li><strong>ECG<\/strong>. For the evaluation of ischemia, and MI<\/li><li><strong>Brain CT<\/strong>. For the evaluation of bleeding, stroke, and encephalopathy.<\/li><li><strong>Eye exam<\/strong>. For the evaluation of retinopathy.<\/li><li><strong>Chest X-ray<\/strong>. For the evaluation of pulmonary edema.<\/li><li><strong>Urinalysis<\/strong>. For the evaluation of renal damage.<\/li><li><strong>Pregnancy test<\/strong>. For the evaluation of pre-eclampsia\/eclampsia.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">In <strong>hypertensive urgency<\/strong>, oral antihypertensives should be used, including ACEi\/ARB + CCB + thiazide diuretic. Labetalol can be added to reach BP below 140mmHg.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In a hypertensive emergency, the goal is to reduce blood pressure by at least 25% within an hour; it is not necessary to achieve normal blood pressure.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Admit to ICU<\/li><li>Short-acting IV drugs given:<ul><li>Nitrates<\/li><li>Fenoldopam (dopamine agonist)<\/li><li>Nicardipine (CCB)<\/li><li>Labetalol (beta + alpha1 blocker)<\/li><li>Enalaprilat (ACEi)<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Causes<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Presentation of hypertensive emergency<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis and evaluation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Hypertensive emergencies and urgencies are grouped as hypertensive crises: Hypertensive urgency is defined as severe hypertension (&gt;180\/120 BP) Hypertensive emergency is defined as severe hypertension with end-organ damage (stroke, acute heart failure, aortic dissection) Causes Renal or renovascular disease Renal artery stenosis Nephritic syndrome Eclampsia\/pre-eclampsia Vasculitis Endocrine Hyperaldosteronism Cushing&#8217;s disease and syndrome Pheochromocytoma Acromegaly Thyrotoxicosis [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":22,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9638","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Hypertensive emergencies and urgencies &#8211; 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