CASE REPORT:

HYPERTENSIVE CRISISBLOCK 5

REVIEW of CONCEPTS

HYPERTENSION

2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension. 2007;25:1105–1187.Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.

JNC 7 (2003) ESH-ESC (2007)

CLASSIFYING HTN

CLASSIFYING HTN

2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187

CLASSIFYING HTN

2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187

CLASSIFYING HTN

2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187

SIGNS of END-ORGAN DAMAGE BRAIN: neck artery murmurs, sensory or

motor deficits RETINA: fundoscopic abnormalities HEART: displaced or abnormal apical

impulse, abnormal cardiac rhythms, ventricular gallop, pulmonary rales, peripheral edema

PERIPHERAL ARTERIES: assymetry or reduction of pulses, cold extremities, ischemic skin lesions

CAROTID ARTERIES: systolic murmur

HTN: END-ORGAN DAMAGE

2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187

…severe elevation of BP

without progressive target organ dysfunction

…severe elevation of BP complicated by

evidence of impending or progressive target organ dysfunction

HTN URGENCY

HTN EMERGENCY

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.

HTN CRISIS: URGENCY or EMERGENCY

HTN CRISIS: TREATMENT

OUTPATIENT or SAME-DAY

OBERVATION

Oral antihypertensiv

esGOAL: no more than 25% MAP reduction in 1st

24 hours

INPATIENT orINTENSIVE

CARE Parenteral

drugsGOAL: 10% MAP reduction in 1st

hour; 15% reduction in

next 2-3 hours

HTN URGENCY

HTN EMERGENCY

Hypertensive Urgency and Emergency, Resident Rounds. Hospital Physician. March 2007:43-50