Hypertensive Crisis
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1
Hypertensive Crisis
SBP ≥ 180
and/or
DBP ≥ 120
and/or
DBP ≥ 120
2
*Subsets of Hypertensive Crisis*
Hypertensive urgency vs emergency
Hypertensive urgency vs emergency
Urgency: W/o target organ damage
Emergency: with target organ damage
Emergency: with target organ damage
3
Number 1 cause of hypertensive crisis
Nonadherence to antihypertensive regimens
4
Management of Hypertensive Urgency
- Reinstitute oral antihypertensive regimen
- Slowly lower BP over 24-48 H
- Slowly lower BP over 24-48 H
5
General management of Hypertensive Emergency
1st hour: reduce SBP by no more than 25%
2-6H: reduce BP to 160/100
6-48H: reduce BP to normal range
2-6H: reduce BP to 160/100
6-48H: reduce BP to normal range
6
Antihypertensives should be administered ___________________ in the ICU for hypertensive emergency.
parenterally
7
*Aortic Dissection*
Type A vs Type B
Type A vs Type B
A - dissection in the ascending aorta
B - dissection in aortic arch or descending aorta
B - dissection in aortic arch or descending aorta
8
*Aortic Dissection*
Type A management:
Type A management:
Surgery
9
*Aortic Dissection*
Type B management:
Type B management:
Beta blockers +/- vasodilator +/- surgery
(Esmolol or Labetalol)
(Nicardipine or Nitroprusside)
(Esmolol or Labetalol)
(Nicardipine or Nitroprusside)
10
Goal HR for Type B Aortic Dissection
HR < 60 bpm
11
For Type B Aortic Dissection the target SBP is < ________ mm Hg within 20 minutes.
120
12
Acute Ischemic Stroke BP Goals
1. W/O alteplase:
2. Prior to alteplase
3. After alteplase:
1. W/O alteplase:
2. Prior to alteplase
3. After alteplase:
1. ≤ 220/110 mm Hg
2. < 185/110 mm Hg
3. < 180/105 mm Hg
2. < 185/110 mm Hg
3. < 180/105 mm Hg
13
What are the preferred agents for BP lowering in Acute Ischemic stroke?
Nicardipine, Labetalol, Clevidipine
14
What is the Goal SBP in Acute Hemorrhagic Stroke?
SBP < 140 mm Hg
15
Management of Severe Preeclampsia and Eclampsia
- Seizure prophylaxis (Magnesium sulfate)
- BP control (Labetalol, Hydralazine, Nicardipine)
- BP control (Labetalol, Hydralazine, Nicardipine)
16
What is a Sympathetic Crises?
excess catecholamines cause BP elevation
17
Drugs used in Sympathetic Crises Management
Clevidipine, Nicardipine, Phentolamine
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