HYPERTENSIVE EMERGENCIES

Posted by e-Medical PPT
“accelerated hypertension”
 term used to describe individuals with chronic hypertension with associated group 3 Keith-Wagener-Baker retinopathy
“malignant hypertension”
 describe those individuals with group 4 KWB retinopathy changes + papilledema

HPT emergency(crisis):  Is characterized by a severe elevation in BP, complicated by evidence of impending or progressive target/end organ dysfunction
HPT urgency: is a severe elevation in BP without progressive target organ dysfunction

Conditions constituting evidence of end organ dysfunction
Hypertensive encephalopathy
Intracerebral heamorrhage
Stroke
Head trauma
Ischemic heart disease (most common)
 AMI
 Acute LVF with P/oedema
 Unstable angina
Aortic dissection
Eclampsia
Life threatening arterial bleed

Prevalence:
With  progress in anti-hypertensive Rx  – decrease in the lifetime incidence of HPT emergencies from 7% to 1%
Hypertensive crisis more common among elderly and black patients
Studies – HPT related problems amount for 25% of all pt visits to medical section of ED. 33% of these - HTN emergencies.

Etiology
Most common
rapid unexplained rise in BP in pt with chronic essential HPT
most have history of poor treatment/compliance or an abrupt discont of their meds

Other causes
Renal parenchymal disease (80% of sec.causes)
Systemic disorders with renal involvement (SLE)
Renovascular disease (Atheroscleroses/fibromuscular dysplasia)
Endocrine ( phaeochromocytoma/cushing syndrome)
Drugs (cocaine/amphetam/clonidine withdrawal/diet pills)
CNS (trauma or spinal cord disorders – Guillain-Barre
Coarctation of the aorta
Preeclampsia/Eclampsia

Hypertensive encephalopathy
Clinical manifestation of cerebral edema and microhemorrhages seen with dysfunction of cerebral autoregulation
Defined as an acute organic brain syndrome or delirium in the setting of severe hypertension
Not adequately treated – cerebral heamorrhage, coma and death.
BUT with proper treatment – completely reversible.

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