ICU Management of Hypertension
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First Things First (assess & treat for the following)
- 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)
- 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)