Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
severe HTN .pdf
1. Severe HTN
Severe HTN
Definition SBP >180 mmHg and/or DBP >120 mmHg.
Severe asymptomatic HTN / Hypertensive urgency
Definition Severe HTN without signs & symptoms of acute end-organ damage.
Treatment •Treat with oral medications:
-Short acting - Clonidine / Captopril.
Severe symptomatic HTN / Hypertensive emergency
Definition Severe HTN with signs & symptoms of acute end-organ damage.
Etiology •Medication non-compliance: most common cause of severe HTN.
•Sudden discontinuation of short-acting antihypertensives (e.g. Clonidine).
•Patients which taking MAOIs and ate Tyramine-rich foods (e.g. wine, cheese, smoked meats).
•Drug overdose: Cocaine, Amphetamines and Phenylcyclohexylpiperidine (AKA angle dust).
Symptoms •Headache: most common.
•Vision changes: most common.
•Dyspnea: may result from acute pulmonary edema.
•Hypertensive encephalopathy: altered mental status, seizures & coma.
•Stroke: focal neurologic symptoms, suggest stroke in contrast to the generalized neurologic symptoms of hypertensive encephalopathy.
•Posterior reversible encephalopathy syndrome (PRES):
-Syndrome characterized by - headache, confusion, seizures and visual loss (symptoms tend to resolve after a period of time, although visual
changes sometimes remain).
-Vasogenic edema - the malignant hypertension cause the breakdown of the tight endothelial junctions that make up the blood–brain barrier —>
allows intravascular proteins and fluid to penetrate into the parenchymal extracellular space —> once plasma constituents cross the barrier, the
edema spreads (this may be quite rapid and extensive).
•Chest pain: may suggest MI / aortic dissection.
Signs •Fundoscopy: flame hemorrhages, cotton-wool spots, papilledema which suggest hypertensive retinopathy.
•Pulmonary auscultation: crackles which suggest acute hypertensive pulmonary edema.
Lab &
tests
•Elevated creatinine: suggests acute hypertensive nephrosclerosis.
•Urine analysis: microscopic hematuria may be seen in 75% of patients with HTN emergency.
•MRI: required for diagnosis of PRES ( look for posterior cerebral white matter edema).
2. Severe HTN
Treatment •Lowering severe HTN should gradual:
-In the first hour - no more than 20%.
-In the next 23 hours - additional 5%-10% (typically ~160/110).
•Treat with IV medications: Hydralazine & Nitroprusside.
•Transition to oral antihypertensives after a suitable period (~24 hours) of BP control.
Severe HTN