HYPERTENSION

Overview Hypertension is defined as BP ≥140/90 mmHg. Hypertension can be divided into Primary or Secondary. The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity. For more information on hypertension as a chronic disease click here Life-Threatening Differential Diagnosis Pre-eclampsia Aortic Dissection Thyroid Strom Drug-induced Drug withdrawal Acute

Overview Hypertension is defined as BP ≥140/90 mmHg. Hypertension can be divided into Primary or Secondary. The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity.

Life-Threatening Differential Diagnosis

  • Pre-eclampsia
  • Aortic Dissection
  • Thyroid Strom
  • Drug-induced
  • Drug withdrawal
  • Acute Renal Failure
  • Stroke
  • Acute pulmonary edema

Management of Chronic Hypertension

  • Education
  • Sodium reduction
  • Diet – high fruit and veg, whole grains, low sodium, low-fat proteins
  • Waist circumference reduction
  • Increase physical activity – 30 min a day
  • Limit alcohol consumption
  • Smoking cessation
  • Management of sleep apnoea
  • Monitoring

  • Approach

     

    History – rule out symptomatic hypertension

    • Chest pain, headache, dizziness, or visual changes
    • Urinary changes
    • Tremors, anxiousness

    Examination

    • Assess orientation
    • Cranial nerve
    • Brief upper and lower neurological examination
    • Cardiovascular examination

    Investigations

    • ECG
    • Bloods – EUC, FBC
    • Urine dipstick (for preeclampsia)

    Management of Hypertensive Urgency

    Hypertensive urgency is defined as BP ≥140/90 mmHg. Hypertension can be divided into Primary or Secondary. The main goal of treatment is to decrease the risk of mortality and of cardiovascular and renal morbidity.

      • Nifedipine
      • Prazosin

    Management of Hypertensive Emergency

    Hypertensive emergency is elevated BP (usually systolic BP >210 mmHg and diastolic BP >130 mmHg) with rapid deterioration of vital organ function, resulting in symptoms such as encephalopathy, retinopathy, myocardial ischemia, or renal failure. This is a life-threatening even

    Management

    • Bolus 1mg (up to 5mg
      • Metoprolol IV
      • Hydralazine IV
    • Antihypertensive Infusion
      • Labetalol IV – is the drug of choice in situations characterized by markedly elevated intracranial pressure
      • Esmolol IV
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