Approach to the Hypertensive Patient

Acute HypertensionJay Patel, MDCR FIRM C

Initial EvaluationWhat are the vitals?EKGIs this new or old?What has the rate of increase been?Is the patient mentating well?Are there signs of acute end-organ damage?

Acute HypertensionIs it urgent or emergent?Urgent SBP >180 or DBP >120Emergent Urgent + End-organ damageEnd-organ damageCardiac: pulmonary edema, ACS, aortic dissectionRenal: ARF, proteinuria, hematuria ATN Neuro: cerebral edema, CVA, TIA, ICHMany patients will have headache from hypertensive urgency but no other end organ damage.Ophtho: retinal hemorrhage/exudate, papilledema

Acute HypertensionPresentations c/w hypertensive emergency:BP >180/100ANDEncephalopathyDyspneaChest painThings Not to missAortic DissectionIntracranial BleedingAcute Coronary Syndromes

Treatment: Hypertensive urgencyTitrate up current medications, Q2H BP checks until