Hypertensive Emergencies

A Hypertensive emergency is any elevation in blood pressure in the presence of end-organ dysfunction. Aggressively treating severe asymptomatic hypertension (very high blood pressure without clear end organ damage) is not indicated, not supported by the literature and DANGEROUS. First, do no harm.

Asymptomatic Hypertension

There is no need to immediately reduce the BP in an asymptomatic patient with a high blood pressure…

BP 252/130…start IV Fluids…this won’t blow up the patient…

  The diagnosis of hypertensive emergency is made based upon the findings of hypertension in the setting of end-organ damage (usually heart, brain, or kidneys). What you really care about is the rate of increase rather than the actual BP number (there is no defining threshold).

Think before pulling the trigger: HTN Emergency

Key Points in High BP management: Don’t get worried with numbers, treat only if the patient is symptomatic. Asymptomatic HTN goes home with good follow up/discharge instructions. High BP + end organ damage is HTN emergency, again don’t look at specific numbers to call it HTN emergency. Reduce MAP by 20-25% in the first hour […]

Treat the patient not the monitor

If your patient doesn’t have any of the conditions below, then their 200/110mmHg pressure won’t kill them but there is a good chance you will by trying to lower their blood pressure acutely in the ED… treat the patient not the monitor  

Elevated Asymptomatic Hypertension: To Treat or Not to Treat?

Patients with markedly elevated blood pressure (SBP ≥ 160 mmHg, DBP ≥ 100 mmHg) require neither screening diagnostic studies nor acute treatment in the emergency department, as long as they are asymptomatic. Initiation of therapy may be considered in special patient populations, such as those with poor follow up.

Latest guidelines for the management of Hypertension – JNC VIII

Recommendation 1 In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation – Grade A) Corollary Recommendation […]

Emergency Medicine Kenya Foundation

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