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HYPERTENSION CRISIS
Classification:
Emergency Hypertension target organ damage,
HYPERTENSION CRISIS
Clinical Manifestation
Neurology
Headache, blurry vision, seizures, focal neurological
Ophthalmology
Retinal bleeding, exudates, papillae edema
Cardiovascular
Chest pain, pulmonary edema
Kidney
Azotemia, proteinuria, oliguria
Obstetric
Preeclampsia, eclampsia
HYPERTENSION CRISIS
Management
Ideally treatment be administered in the hospital, however it can be started in
primary health care with oral anti hypertension
Medicine
Route
Pharmacology
Dose
ACE Inhibitor
(Captopril)
Sublingual
Oral
6,25-50 mg /x
Central alpha
agonist (Clonidin)
Oral
75-150 ug/x/hour
Total 900 ug
Calcium Channel
blocker
(Nifedipine)
Oral
As alternative if
other medicine not
available
HYPERTENSION CRISIS
Management
Drugs
Route
Clonidin
(catapres)
150
mcg/amp
Diltiazem
(Herbesser)
10 mg & 50
mg/amp
Nicardipine
(Perdipine)
2 & 10
mg/amp
Drugs
Route
Labetalol
(Normodyn)
IV
Nitroprusside
(Nitropress,
Nipride)
IV
HYPERTENSION IN SPECIAL
CONDITIONS
Heart Failure
Diuretics, B Blockers, ACE-I
Hypertension in Elderly
life expectancy
SBP 140 mmHg if DM, smoker, or other
risk factors
Target
65-79 yo
>80 yo
Hypertension in Neurological Ds
Ischemic stroke
anti hypertension not recommended unless
SBP>220 mmHg DBP>120 mmHg
Hemorrhagic stroke
anti hypertension not recommended unless
SBP >180 mmHg or MAP > 130 mmHg
Hypertension in
Diabetes
HYPERTENSION IN
PREGNANCY
DEFINITION : SBP 140 mmHg and/or
DBP 90 mmHg
or
rise in SBP 30 mmHg and/or DBP 15
mmHg from preconception
HYPERTENSION IN
PREGNANCY
CLASSIFICATION
1.
2.
3.
4.
Chronic Hypertension
Preeclampsia - Eclampsia
Preeclampsia - Eclampsia Superimposed on
Chronic Hypertension
Gestational Hypertension
1. Chronic Hypertension
Preexisting Hypertension
Definition
Systolic pressure 140 mmHg, diastolic
Causes
Primary = Essential Hypertension
Secondary = Result of other medical
2. PreeclampsiaEclampsia
pressure 90 mmHg
Proteinuria of 0.3 g or greater in a 24-hour urine
specimen
Preeclampsia <20 weeks, think MOLAR PREGNANCY!
Categories
Mild Preeclampsia
Severe Preeclampsia
Eclampsia
Occurrence of generalized convulsion and/or coma in
3. Preeclampsia-Eclampsia
superimposed on Chronic
Hypertension
weeks of gestation.
A sudden increase in blood pressure.
Thrombocytopenia.
Elevated aminotransferases.
4. Gestational
Hypertension
Mild hypertension without proteinuria or other
signs of preeclampsia.
Develops in late pregnancy, > 20 weeks
gestation.
Resolves by 12 weeks postpartum.
Can progress onto preeclampsia.
gestation.
HYPERTENSION IN
PREGNANCY
Medical Management:
Acute therapy : IV labetalol, IV Hydralazine,
SR Nifedipine
Long term therapy: oral Labetolol,
Methyldopa, Nifedipine
Eclampsia prevention : MgSO4
HYPERTENSION IN
PREGNANCY
POST PARTUM MANAGEMENT
Continue to watch for maternal
complication first 3-5 days
Tapper oral anti hypertension over a few
days
Monitor laboratory tests and urinalysis to
ensure all abnormalities resolve after
delivery
Review three months post partum
Dose
Preferred Agent
Methyldopa (B)
Concerns or Comments
Drug of choice according to NHBEP safety after
first trimester well documented, including 7
years follow-up
Hydralazine (C)
Hydrochlorothiazide (C)
Concerns or Comments
Labetalol (C)
Hydralazine (C)
30 to 50 mg IV every 5 to 15 minutes
Constant infusion of 0.25 to 5.00g/kg per
minute
NIfedifine(C)
Diazoxide (c)
Relatively CI
nitropusside (C)
Thank You