Hypertensive Crises

Definition and Basics

  • DBP > 120 w/ potential end-organ damage

  • Change in BP over change in time is the key not absolute BP

  • HTN + neuro sx means NO overzealous normalization

  • Decrease BP 20-25% from presenting BP

Ask ABCD

  • Age

  • Allergies

  • BPs (previous)

  • Current medications and what they take at home

  • Diagnostics (i.e. labs)

Medications

  • hydralazine 10-20 mg PO/IV/IM q6°

    • Onset 10-20#

    • Lasts 3-8°

    • Peripheral vasodilator, CO, HR

  • labetalol 20 mg IV q6°

    • Onset 5-10#

    • Lasts 3-6°

    • Beta-blocker can decrease HR

  • enalaprilat 1.25-5 mg IV q6°

    • Onset 15-30#

    • Lasts 6°

    • ACEI, NOT in AKI

  • nicardipine 30 mg PO q8°

    • Calcium channel blocker

  • nitroglycerin 0.4 mg SL q5# ´3

    • 5-200 mcg/min IV

    • 5-10-15-20-30-40-60-80-100-120-140-160-180-200 mcg/min q3-5#

    • Onset 3-5#

  • clonidine 0.1-0.2 mg PO q12°

    • MAX 0.8 mg in 24°

    • alpha2-agonist, rebound HTN