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CASE REPORT:
HYPERTENSIVE CRISISBLOCK 5
REVIEW of CONCEPTS
HYPERTENSION
2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension. 2007;25:1105–1187.Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.
JNC 7 (2003) ESH-ESC (2007)
CLASSIFYING HTN
CLASSIFYING HTN
2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187
CLASSIFYING HTN
2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187
CLASSIFYING HTN
2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187
SIGNS of END-ORGAN DAMAGE BRAIN: neck artery murmurs, sensory or
motor deficits RETINA: fundoscopic abnormalities HEART: displaced or abnormal apical
impulse, abnormal cardiac rhythms, ventricular gallop, pulmonary rales, peripheral edema
PERIPHERAL ARTERIES: assymetry or reduction of pulses, cold extremities, ischemic skin lesions
CAROTID ARTERIES: systolic murmur
HTN: END-ORGAN DAMAGE
2007 Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, 2007, 25:1105–1187
…severe elevation of BP
without progressive target organ dysfunction
…severe elevation of BP complicated by
evidence of impending or progressive target organ dysfunction
HTN URGENCY
HTN EMERGENCY
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.
HTN CRISIS: URGENCY or EMERGENCY
HTN CRISIS: TREATMENT
OUTPATIENT or SAME-DAY
OBERVATION
Oral antihypertensiv
esGOAL: no more than 25% MAP reduction in 1st
24 hours
INPATIENT orINTENSIVE
CARE Parenteral
drugsGOAL: 10% MAP reduction in 1st
hour; 15% reduction in
next 2-3 hours
HTN URGENCY
HTN EMERGENCY
Hypertensive Urgency and Emergency, Resident Rounds. Hospital Physician. March 2007:43-50