Secondary Hypertension and Hypertensive Emergencies.Diagnostic Evaluation and

Treatment

Dr Lázaro N Rodríguez González

Classification of Blood Pressure for Adults Aged 18 Years and Older

• Normal BP = Systolic BP <120mmHg + Diastolic BP <80mmHg

• PreHt = Syst BP 120 – 139mmHg or Diast BP 80 – 89mmHg

• Stage 1 Ht = Syst BP140 – 159mmHg or Dist BP 90 – 99mmHg

• Stage 2 Ht = Syst BP 160mmHg or Diast BP 100mmHg

(JNC VII.2003)

Johnson et al. Cardiol Clin 30 (2012) 533–543

Clinical Evaluation

History Medication

Drugs (meth-amphetamine, Cocaine)

Detailed physical examination looking forpresence of end-organ damageCV examNeurological examination Fundoscopy (Exudates, Hemorrhages, Papilledema)

Investigations

• LAB TESTS U&E, Cr, FBC, cardiac markers

• URINEProtein, urea and casts

• ECGLook for LVH, Myocardial Infarction/Ischemia

• CXRLook at cardiothoracic index/pulmonary edema/widened mediastinum

HT ENCEPHALOPATHY

• Acute organic brain syndrome in the setting of severe hypertension

• Clinical manifestations of cerebral oedema and micro-haemorrhages seen with dysfunction of cerebral autoregulation

HT ENCEPHALOPATHY

• SymptomsSevere headache Nausea VomitingVisual disturbances Confusion Weakness

SignsDisorientation Focal neurologic defectsNystagmus Focal or generalized seizures

If not properly treated it can lead to cerebral bleeding/infarction, coma and death

With proper treatment, however, it is completely reversible

Summary

• Acute end-organ damage Treat in ICU/HCUWith IV medicationTo achieve prompt but gradual reduction in BP

Lower mean arterial pressure by ± 25% or reduce diast BP to100-110mmHg

NB Be careful not to drop intravasc volume too rapidly cardiac or cerebrovascular hypoperfusion

Management of Ht emergencies should be individualized and should be specific to end-organ at risk

THE END