Hypertensive Crises

Posted by e-Medical PPT Saturday, August 25, 2012
Hypertensive Emergency: Very high BP with acute end-organ damage or a clinical setting that could be immediately life-threatening therefore need to lower BP in a matter of minutes with parenteral drugs in an ICU

Hypertensive Urgency: Very high BP without acute end-organ damage or only retinal changes, therefore BP can be lowered in hours to days, preferably slowly, sometimes in an outpatient setting

Hypertensive Crisis Criteria
Level of blood pressure and/or rapidity of increase
 Life-threatening involvement of CNS or cardiovascular system and/or a clinical setting deemed dangerous

The Clinical Syndromes of Severe Hypertension
_Malignant hypertension
_Hypertensive encephalopathy
_Benign hypertension with acute dysfunction of neurologic or cardiovascular system
_Catecholamine excess states
_Preoperative and postoperative hypertension
_Preeclampsia and eclampsia
_Scleroderma  renal crisis, acute glomerulonephritis

Malignant or Accelerated Hypertension: Essential Diagnostic Features
Elevation of blood pressure, usually severe and fixed, occurring over days to weeks
Grade III or IV hypertensive retinopathy
Renal abnormalities: proteinuria, microscopic hematuria, renal dysfunction
Progressive decline of kidney function

Etiologies of Malignant Hypertension
Primary or essential malignant hypertension

Secondary malignant hypertension
  Acute glomerulonephritis
  Renovascular hypertension
  Chronic kidney diseases
All causes of hypertension can evolve to malignant hypertension with the exception of coarctation of the aorta
Malignant hypertension has been reported with primary aldosteronism, Cushing’s syndrome and pheochromocytoma but very infrequently
Primary or essential hypertension is the most common etiology overall, particularly among persons of African descent.
Primary or essential hypertension as a cause of malignant hypertension is less common among caucasians and children
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