Hypertensive Emergencies

Hypertensive Emergencies

Hypertensive Emergencies is very high blood pressure that comes on suddenly and quickly. The lower (diastolic) blood pressure reading, which is normally less than 80 mmHg, is often above 130 mmHg.

Causes

• high blood pressure
• Collagen vascular disorders (such as systemic lupus erythematosus, systemic  sclerosis,and periarteritis nodosa)

     •       Kidney problems

     •     Toxemia of pregnancy

     •      Kidney failure

     •     Renal hypertension caused by renal artery stenosis

Symptoms

•             Blurred vision

•             Change in mental status, such as: Anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue, restlessness, sleepiness, stupor, lethargy

•             Chest pain (feeling of crushing or pressure)

•             Cough

•             Headache

•             Nausea or vomiting

•             Numbness of the arms, legs, face, or other areas

•             Reduced urine output

•             Seizure

•             Shortness of breath

•             Weakness of the arms, legs, face, or other areas

Investigations

1. Physical exams - commonly shows:

• Extremely high blood pressure
• Swelling in the lower legs and feet
• Abnormal heart sounds and fluid in the lungs
• Changes in thinking, sensation, muscle ability, and reflexes

2.  Arterial blood gas analysis

3. BUN

4. Creatinine

5. Urinalysis

Treatment

1. Sodium nitroprusside

2. Labetalol

3. Fenoldopam

4. Clevidipine,

REFERENCES

• Hypertensive crisis. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp. Accessed May 09, 2015.
• Tulman DB, et al. Advances in management of acute hypertension: A concise review. Discovery Medicine. 2012;13:375.
• Kaplan NM. Malignant hypertension and hypertensive encephalopathy in adults. http://www.uptodate.com/home. Accessed May 09, 2015.
• Varon J, et al. Management of severe asymptomatic hypertension (hypertensive urgencies) in adults. http://www.uptodate.com/home. Accessed May 09, 2015.
• The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/. Accessed May 09, 2015.