Hypertensive Urgency: Severely elevated blood pressure with SBP
>180 or DBP >110 without target organ damage.
Hypertensive Emergencies: Elevated blood pressure with target organ damage like
CNS, CVS and the renal system.
1. Malignant Hypertension: papilledema is essential for diagnosis.
2. Accelerated Hypertension: A recent significant increase of blood pressure
with associated target organ damage e.g. vascular damage on funduscopic
examination with flame shaped hemorrhages or soft exudates.
ER:
Routine labs
EKG
CXR
Oxygen
Labetalol IV
Hydralazine IV-in pregnancy
By Hospitalist:
Telemetry
Bed rest
Low salt diet
Labetalol PO if no contraindications/Hydralazine PO/Nicardipine PO/Clonidine PO
Lipid profile
Urine Toxicology
Cardiac enzymes
ECHO
Renal Arterial Duplex if Renal Arterial Stenosis suspected
Some common IV bolus medications for managing high BP:
Hydralazine 10mg IV Q 20min if needed but I prefer to use every 6hrs for SBP more than150mm Hg
Vasotec (Enalapril) 1.25-2.5 mg IV Q 6hrs
Metoprolol 2.5-5mg IV q 4hrs, I use for high BP in NPO patients who were on Beta blockers prior to admission to prevent withdrawal tachycardia.
Hypotension:
If BP is low, put patient in Trendelenburg Position.
Give IV fluid boluses with NS 2-3Liters. If patient does not respond then Epinephrine (Levophed) drip
Dopamine drip
Tests for Secondary Hypertension:
Plasma Metanephrines, 24hr Urine Catecholamines, 24hr urine metanephrines, 24hr urine cortisol
US Retro arterial Venous duplex
