Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Blood pressure > 180/120 mm Hg Symptoms and signs of encephalopathy, acute myocardial ischemia, stroke, pulmonary edema, or aortic dissection +++ GENERAL CONSIDERATIONS ++ Hypertensive emergencies: – Severely elevated blood pressure with symptoms and signs of damage to the heart, brain, kidneys, or vascular system. – Can be the first presentation of hypertension or can occur in patients known to have hypertension Hypertensive urgencies are described as the same severely elevated blood pressure levels as in hypertensive emergencies and symptoms but without signs of target organ damage. +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Symptoms of the target organ problem, such as headache and lethargy with encephalopathy +++ PHYSICAL EXAM FINDINGS ++ Blood pressure > 180/120 mm Hg Findings of the target organ problem, such as localizing neurologic findings in stroke +++ DIFFERENTIAL DIAGNOSIS ++ Increased intracranial pressure—lowering blood pressure contraindicated Acute drug-induced pressure elevation (eg, cocaine) +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Serum catecholamines: to check for pheochromocytoma Toxic drug screen Target organ damage tests such as creatinine, troponin, B-type natriuretic peptide, D-dimer +++ ELECTROCARDIOGRAPHY ++ ECG findings: – Signs of acute myocardial ischemia or infarction – Nonspecific ST-T–wave changes – Left atrial and ventricular hypertrophy +++ IMAGING STUDIES ++ As indicated for organ problem, such as echocardiography for heart failure +++ DIAGNOSTIC PROCEDURES ++ As indicated for organ problem, such as coronary angiography for acute ST-segment elevation myocardial infarction +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Myocardial infarction Heart failure +++ HOSPITALIZATION CRITERIA ++ Encephalopathy Acute myocardial ischemia/infarction Heart failure Stroke Aortic dissection +++ MEDICATIONS ++ Nitroprusside 0.25–1.0 μg/kg/min, increase by 0.5 μg/kg/min every 5 minutes until goal or until maximum dose of 10 μg/kg/min Fenoldopam 0.03–0.1 μg/kg/min; increase by 0.05 μg/kg/min up to 1.6 μg/kg/min Labetalol 20–40 mg IV every 10 minutes to 300 mg Esmolol 0.5–1.0 mg/kg over 1 minute, then 50–300 μg/kg/min Clevidipine 1–2 mg/hour, titrate to 32 mg/hour Nicardipine 5 mg/hour, increase by 2.5 mg/hour every 15–30 minutes until goal blood pressure or 15 mg/hour reached Phentolamine 1–5 mg, repeat after 5–15 minutes until goal blood pressure reached or 0.5–1.0 mg/hour continuous infusion Nitroglycerin 10–20 μg/min, increase by 5 μg/min every 5 minutes until goal blood pressure or 200 μg/min reached +++ THERAPEUTIC PROCEDURES ++ For specific organ problems as indicated, such as angioplasty for acute ST-segment elevation myocardial infarction +++ SURGERY ++ As indicated for organ ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth