Systemic HypertensionPaleerat Jariyakanjana, MD

Faculty of MedicineNaresuan University

28 Mar 2014

Definition of Terms

Definition of Terms

Hypertensive crises hypertensive urgencyhypertensive emergency 

Definition of Terms

Hypertensive emergencyacute elevation of blood pressure

(≥180/120 mm Hg) associated with end-organ damage

Definition of Terms

Definition of Terms

Definition of Terms

Hypertensive urgencysevere elevations in blood pressure

without progressive target organ dysfunction

Diagnosis

Validity of ED-Identified Hypertensionfew blood pressure changes occurred

after 20 minutes from ED arrivalblood pressure measurements at 60-

80 minutes after arrival may be the most predictive of chronic hypertension

Treatment

Emergency: MAP by 25% in mins-2 h w/ IV agents; goal DBP <110 w/in 2–6 h, as tolerated

Urgency: BP in hours using PO agents; goal normal BP in 1–2 d

Pocket medicine, 4th edition

Treatment

Treatment

Treatment

Treatment

Pocket medicine, 4th edition

Disposition and Follow-Up

Disposition and Follow-Up

Recommendations for initial therapy thiazide diuretic: HCTZ (25) 1x1 ACEIs: lisinopril (10) 1x1

Disposition and Follow-Up

Disposition and Follow-Up

Reference

Tintinalli's Emergency Medicine, 7th edition

Pocket medicine, 4th edition

ANY QUESTIONS?