Hypertensive Crisis

 Is defined as an acute rise in BP

usually with diastolic BP over
120mmHg with or without end
organ damage.
 It is further classified into :
• Hypertensive emergencies
- Increased BP with evidence of end organ
damage or dysfunction.
- End organ manifestations include:
-Retinal (papilloedema)
-Cardiac (pulmonary edema, myocardial
ischaemia such as unstable angina or
infarction)
-Neurological (eg severe headache, mental
status changes, seizures, coma
--Renal (eg acute renal failure)
 Hypertensive urgency

- Elevation of BP to a level which maybe

potentially harmful but without signs,
symptoms or other evidence of end organ
damage.
Management
 General principles :

- in hypertensive emergencies, BP control

should be accomplished within a few hours
to reduce the risk of permanent damage or
death

- Diastolic of 100 to 110 mmHg may be

adequate for the first 24 hours.

- IV antihypertensive agents should be used.

 In hypertensive urgencies, BP control can be
accomplished more slowly with oral antihypertensive
agents within 24 to 48 hours to a diastolic level of
100 to 110 mmHg initially.

 Excessive or rapid decrease in BP should be avoided

to minimize the risk of cerebral hypo perfusion or
coronary insufficiencies.

 BUSEC, urinalysis, CXR and ECG should be

performed urgently.
 Drugs of choice for management;
a. CAD and HF : IV nitroprusside or IV nitroglycerin

b. Pheochromocytoma : IV phentolamine or alpha –

blocker e.g prazosin

c. Aortic dissection : IV beta-blocker or labetolol

d. Pulmonary edema : IV frusemide , IV nitroglycerin,

IV nitroprusside, ACEI/ARB

e. Stroke : Beta blocker, CCB, diuretic or ACEI/ARB

f. sublingual nifedipine should be avoided

 Oral antihypertensive agents
-Can be used in patients with hypertensive crisis
when urgent but not immediate reduction of BP is
indicated.
- Combination theraphy is neccesary in most cases
when diastolic BP is more than 110mmHg.
- AB + CD
- Beta-blockers eg atenolol 50 -100 mg or labetalol
200-400mg with or without diuretics, ACEI/ARB eg
captoril 12.5-25mg with or without diuretics followed
by maintenance maybe all that is required.
- CCB eg amlodipine, felodipine or nifedipine can also
be used.
 Subsequent Therapy

 Investigate for possible underlying causes.

 If parenteral agents are used initially, oral

medications should me administrated in
combination shortly thereafter to facilitate weaning
from parenteral theraphy (over 1 to 2 days)