severe hypertension
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Severe HypertensionUrgencies and Emergencies
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Presentation
• Asymptomatic
• Non-specific: dizziness, headache etc.
•
Symptoms and sign of acute taget ogandamage: acute coonay syndome, acute heat
fai!ue, sto"e, acute ena! fai!ue, hypetensi#e
encepha!opathy, dissecting aneuysm
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Our Role?•
Histoy (H+N and othe causes)• Physica! eamination
– Pu!se: &ate, hythm, de!ays
– BP
– Pecodium: $ocation and chaacte of ape eat,
Auscu!tate fo heat sounds, eath sounds (iasa!
cepitation)
– Adomen: Pa!pation, auscu!tation fo ena! uit
– Fundoscopy
– %thes
• gent in#estigations: depending on situation / &BS,
*0, uine dipstic" etc.
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Then, patients can be classified:
• Asymptomatic se#ee hypetension
• Hypetensi#e ugencies
• Hypetensi#e emegencies
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Hypertensive Urencies
• 0ade 111 o 12 etina! changes,
poteinuia 34 ut no o#et ogan fai!ue
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!anae"ent
• 5ay e admitted
• 5easuement of BP afte 67 minutes of ed
est
• Aim of theapy: 489 of eduction of BP ut no
!ess than ;7
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Oral treat"ent for HT# urencies
#rug #ose $mg% Onse& o'ac&ion$"our%
#ura&ion$"our%
Fre(uency$prn%
*aptopi! 48 7.8 ; / 4 hous
Nifedipine 7 / 47 7.8 6 / 8 / 4 hous
$aeta!o! 477 / 77 4 ; hous
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Hypertensive $"erencies
• Any patient 'ith comp!ications of se#ee
hypetension i.e. acute taget ogan
damage e#en if BP is !ess than ?7
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!anae"ent
• MUST BE )#M*TTE#
• Aim of theapy: 489 of eduction of BP
depending on scenaio ut no !ess than ;7
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Treat"ent Options for HT#
$"erencies
#rug #ose $mg% Onse& o'ac&ion
#ura&ion .emars
Sodium Nitopusside
7.48 / 7@g
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Treat"ent Options for HT#$"erencies %contd&'
#rug #ose $mg% Onse& o'ac&ion
#ura&ion .emars
Nitates 8 / 77 @g<min
4 / 8 minutes 6 / 8 minutes Pefeed inacute
coonaysyndomesand acute
pu!monayoedema
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Treat"ent Options for HT#$"erencies %contd&'
#rug #ose $mg% Onse& o'ac&ion
#ura&ion .emars
Hyda!azine 12 8 / 7 mgmaye
epeated afte47 / 67minutes477-677mcg
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Treat"ent Options for HT#$"erencies %contd&'
#rug #ose $mg% Onse& o'ac&ion
#ura&ion .emars
Nicadipine 12 o!us 7-67mcg
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Su""ary
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