ICU Management of Hypertension

First Things First (assess & treat for the following)

• Definitions
  • Hypertension (HTN), as described by JNC VII, is BP >140/90 on more than one occasion. Hypertensive urgency is severe HTN (typically systolic >180 or diastolic BP >120) without symptoms or end-organ damage (ie, without evidence of CNS, CV, renal or retinal dysfunction).
  • Hypertensive emergency: an acute, life-threatening event requiring immediate treatment
    • Textbook definition: diastolic BP >140 accompanied by end-organ damage
    • The rate of increase in BP can be just as important as absolute BP numbers, particularly in previously normotensive pts.
    • Malignant hypertension is a subtype of HTN emergency, with findings typically focused on the eye.
    • HTN encephalopathy is another subtype of HTN emergency centering on cerebral edema and its associated findings.
• Differential includes:
  • Essential HTN
  • Renal (acute glomerulonephritis, vasculitis, renal artery stenosis)
  • CNS (head injury, hemorrhage)
  • Eclampsia
  • High catecholamine states (pheochromocytoma, drug ingestions such as cocaine & amphetamines, rebound HTN from stopping antihypertensives, tyramine ingestion with MAO inhibitors & postop HTN)
  • Miscellaneous (medicine noncompliance, severe burns, severe pain, or autonomic dysfunction from spinal cord injury or Guillain-Barre syndrome)