Armando hasudungan brain logo

Hypertension

Overview

Hypertension is defined as BP ≥140/90 mmHg. Hypertension can be divided into Primary or Secondary. The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity.

For more information on hypertension as a chronic disease click here

Life Threatening Differential Diagnosis

  • Pre-eclampsia
  • Aortic Dissection
  • Thyroid Strom
  • Drug induced
  • Drug withdrawal
  • Acute Renal Failure
  • Stroke
  • Acute pulmonary oedema

Management of Chronic Hypertension

  • Education
  • Sodium reduction
  • Diet – high fruit and veg, whole grains, low sodium, low fat proteins
  • Waist circumference reduction
  • Increase physical activity – 30 min a day
  • Limit alcohol consumption
  • Smoking cessation
  • Management of sleep apnoea
  • Monitoring

Approach

  • History – rule out symptomatic hypertension
    • Chest pain, headache, dizziness or visual changes
    • Urinary changes
    • Tremors, anxiousness
  • Examination
    • Assess orientation
    • Cranial nerve
    • Brief upper and lower neurological examination
    • Cardiovascular examination
  • Investigations 
    • ECG
    • Bloods – EUC, FBC
    • Urine dipstick (for preeclampsia)

Management of Hypertensive Urgency 

Hypertensive urgency is defined as BP ≥140/90 mmHg. Hypertension can be divided into Primary or Secondary. The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity.

  • Nifedipine
  • Prazocin

Management of Hypertensive Emergency 

Hypertensive emergency is elevated BP (usually systolic BP >210 mmHg and diastolic BP >130 mmHg) with rapid deterioration of vital organ function, resulting in symptoms such as encephalopathy, retinopathy, myocardial ischaemia, or renal failure. This is a life threatening event.

Think check the patients baseline BP. If normally very high, its less concerning but still life threatening conditions should be ruled out.

Management

  • Bolus 1mg (up to 5mg)
    • Metoprolol IV
    • Hydralazine IV
  • Antihypertensive Infusion
    • Labetalol IV – is drug of choice in situations characterised by markedly elevated intracranial pressure
    • Esmolol IV
Remember For pregnant women oral methyldopa, nifedipine or labetolol can be used. For Pre-eclampsia oral nifedipine or intravenous labetalol or hydralazine.

 

Discussion

0 Comments
Most Voted
Newest Oldest
Inline Feedbacks
View all comments

Table Of Contents

Join the community focused on quality medical education
Stay up to date on new content, features, and exciting community announcements.
Please enable JavaScript in your browser to complete this form.
Become a member to access note taking
Orangise your medical learning
This is just one of the many AH community member perks
Become a member to access quizzes
Strengthen your medical knowledge
This is just one of the many AH community member perks
0
Would love your thoughts, please comment.x
()
x