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Dealing With Hypertensive Emergency and Urgency .6
Dealing With Hypertensive Emergency and Urgency .6
Dealing With Hypertensive Emergency and Urgency .6
P
Peter Thurgood, 74, arrives at your hospital’s emergency
department (ED) feeling miserable, complaining of a se- Behind the high rise
vere occipital headache, nausea and vomiting, and blurred Hypertensive crises may arise as the result of one or
vision; his skin also appears flushed. When checking his vi- more of the following:
• acute glomerulonephritis
tal signs, you discover that his blood pressure (BP) is
• autonomic dysreflexia in the presence of spinal cord
220/140 mm Hg.
injury
Mr. Thurgood tells you that to treat his hypertension, • chronic parenchymal renal disease
for the last 3 years or so, he’s been taking Prinzide, a com- • combining a monoamine oxidase inhibitor and
bination of lisinopril, an angiotensin-converting enzyme tyramine-containing foods (such as soy sauce, sauer-
(ACE) inhibitor and hydrochlorothiazide, a thiazide-type kraut, aged cheese, pepperoni, salami, liverwurst), tri-
diuretic. But he hasn’t taken the drug for 3 weeks because cyclic antidepressants, or other sympathomimetics
his prescription ran out and he couldn’t afford to refill it. • eclampsia, preeclampsia
Based on Mr. Thurgood’s history and your assessment • head injury
findings, you suspect that he’s experiencing a hypertensive • illicit use of sympathomimetic drugs such as cocaine,
crisis. This condition can occur in patients who have amphetamines, PCP, and LSD
• pheochromocytoma
poorly controlled hypertension or, as in Mr. Thurgood’s
• renin-secreting or aldosterone-secreting tumor
case, have abruptly stopped taking their antihypertensive
• renovascular hypertension
medications. For more information on the causes of hy- • scleroderma and other collagen vascular diseases
pertensive crises, see Behind the high rise. • too-rapid withdrawal from antihypertensive medica-
Now let’s look at how to safely lower Mr. Thurgood’s tions
soaring BP as quickly as possible. • vasculitis.
A wider window of opportunity The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure, Publication
In a hypertensive urgency, the window of opportunity for No. 04-5230. Bethesda, Md., National Institutes of Health, August 2004.
treatment is open a bit wider because no target organ dam- Adapted and updated from When blood pressure goes up, up, and away!
age has occurred. The BP can be lowered gradually over 24 Nursing made Incredibly Easy! July/August 2005.