Hypertensive Crisis
Hypertensive Crisis: A severe and abrupt elevation in blood pressure, with a systolic BP above 180 mmHg and a diastolic BP above 120 mmHg.
Hypertensive crisis is acute and life-threatening, this requires emergency treatment due to target-organ damage which is called hypertensive emergency. If the patient’s blood pressure is severely elevated but there is no clinical evidence of target-organ damage therefore this is categorized as hypertensive urgency.
Signs and symptoms
High blood pressure (diastolic pressure higher than 120 mm Hg)
Headache
Drowsiness and confusion
Blurred vision
Changes in neurological status
Tachycardia and dyspnea
Cyanosis
Seizures
Interventions
Maintain a patent airway.
Hypertensive emergency: Administer antihypertensive medications intravenously as prescribed e.g., nitroprusside (Nitropress), diazoxide (Hyperstat), nicardipine (Cardene), or labetalol (Trandate).
Hypertensive urgency: Administer antihypertensive medications orally as prescribed e.g., clonidine (Catapress) or captopril (Capoten).
Monitor vital signs (especially blood pressure) every 5 minutes.
Assess for hypotension during treatment of antihypertensives; if it occurs position the patient in supine.
Maintain bed rest with the head of the bed elevated at 45 degrees.
Have emergency medications and resuscitation equipment available.
Main causes
Patients with hypertension who are noncompliant to their prescribed medication or undermedicated.
Use of cocaine or crack, amphetamines, phencyclidine (PCP), and lysergic acid diethylamide (LSD).
Patients who are taking monoamine oxidase inhibitors (MAOIs) who consume foods rich in tyramine.
Potential complications
Hypertensive encephalopathy
Intracranial or subarachnoid hemorrhage
Acute left ventricular failure with pulmonary edema
Myocardial infarction
Renal failure and dissecting aortic aneurysm
Laboratory assessments/Diagnostic Test
Monitor intake and output; if oliguria or anuria occurs, notify the physician.
Monitor IV therapy; assessing for fluid overload.
Education
Determine and avoid the cause of the hypertensive crisis (e.g., compliance to medication, avoiding illicit drugs, and avoiding tyramine rich foods if taking MAOIs).
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