HTN crisis

1. Hypertensive crisis
Hypertensive Emergency
-SBP > 180 mmhg or
DBP > 120 mmhg
-with end organ damage
-
-Pt needs paranteral TTT
-
- pt needs admission
Hypertensive Urgency
-SBP > 180 mmhg or
DBP > 120 mmhg
-without end organ damage
Pt needs oral TTT
outpatient follow up

2. End organ damage?
1- cardiovasacular:
ACS- pulmonary odema- AOD-
2- NEUROLOGICAL:
stroke-TIA- hypertensive encephalopathy
3- retinal
Papillodema(malignant HTN)
4- Renal
Rapid rise of urea and creatinine, hematuria

3. 5-Hematology: hemolytic anemia
Treamtent of Hypertensive emergency
‫مافيش‬
‫االولى‬ ‫الساعات‬ ‫في‬ ‫الضغط‬ ‫يكون‬ ‫كم‬ ‫على‬ ‫اجماع‬
‫على‬ ‫مجمعين‬ ‫لكن‬
1-Don’t rapidly normalized BP , because of its harmful effect…
2- reduce 25% of SBP in the first hour
Then 160/110- 100 during the next 2-6 hours
Then to normal BP during 1- 2 days

4. note: in eclampsia/ preeclampsia
decrease the SBP to below 140 mmHg in
the first hr
but if plt=100 decrease the SBP to Below
150/100 mmHg

5. Drugs:
1- labetalol (i.v) ( CVA, preeclampsia,pulmonary
odema,ESRF)
Ampule = 20 mg
20, 40 , 80, 80 , 80 mg
Upto 300 mg
every 10 minutes with monitoring of BP
OR infusion( 1-2mg/minute)
100 mg labetalol in 50 cc NS
30 ml/hr

6. 2- Nitroglycerine (i.v) ( pul.odema, ACS)
(10- 200 mcg / minute) > Davidson
(5- 500 mcg/minute) > pocket medicine
50 mg nitroglycerine in 50 cc dextrose 5 %
( 1 ml/hr to 12 ml/hr)

7. 3- Hydralazine (i.v) ampule = 20 mg
give 5 mg iv direct every 15 minutes upto 20-30
mg
Infusion:
(0.5 -10 mg/ hr)
one ampule in 50 cc NS (0 .4 mg = 1 cc )
( 3 ml to 25 ml /hr)