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