What is hypertensive urgency?
Hypertensive urgency occurs when blood pressure spikes high. Blood pressure readings are 180/110 or higher Treatments can be Hydralazine or Labetalol, it is not necessary but is optional. Hypertensive emergency means blood pressure is so high that organ damage can occur. Blood pressure must be reduced immediately to prevent imminent organ damage.
What is the difference between a hypertensive emergency and a hypertension?
In contrast to hypertensive emergencies, hypertensive urgencies are characterized by an acute and critical increase in blood pressure without signs or symptoms of acute hypertensive target organ damage. In these patients, blood pressure should be lowered within 24 to 48 hours in order to avoid hypertensive target organ damage.
What is the difference between emergency and urgency?
2.The main difference between emergency and urgency is that in emergency there is immediate threat to life, health, property or environment; whereas in urgency, there is no immediate danger or threat to life, health, property or environment but if not taken care in a given period of time, then the situation may turn into an emergency situation.
What are the signs and symptoms of hypertensive emergency?
Persons with hypertensive urgency may experience severe headache, shortness of breath, nosebleed, or anxiety.1 With hypertensive emergency, the clinical presentation will depend on the particular organ that is undergoing injury, in addition to other symptoms, such as headache.
What features separate a hypertensive urgency from an emergency?
(C) Signs of end-organ damage are what differentiate Hypertensive Urgency from Emergency, and thus determine the need for emergency treatment. Hypertensive Urgency can be treated with oral or IV medications on the floor with individual doses.
What is considered a hypertensive emergency?
Hypertensive emergency is characterized by an acute, severe elevation in blood pressure, systolic blood pressure higher than 180 millimeters of mercury (mm Hg) or diastolic higher than 120 mm Hg, which is causing damage to at least one target organs, like the brain, heart, kidneys, and vessels.
What is the difference between hypertension and hypertensive crisis?
Hypertension is the medical term for high blood pressure. Hypertensive crisis occurs when a person's blood pressure surges to an unusually high level. This condition can cause damage to blood vessels and major organs.
What causes hypertensive urgency?
The most common cause of hypertensive crisis is a sudden increase in blood pressure in people with chronic hypertension, often caused by medical noncompliance. Other causes of hypertensive crisis may include: Not taking blood pressure medications. Severe stress or anxiety.
How do you treat for hypertensive urgency and hypertensive emergency?
Treatment / Management Patients with a hypertensive emergency need admission with continuous blood pressure monitoring. for adults with no organ damage, lower the blood pressure by 25% in the first hour and then to 160/100 over the next 2-6 hours, and then gradually to normal over 2 days.
Does hypertensive urgency require hospitalization?
Hypertensive emergency is defined as severe blood pressure elevation in the presence of acute target organ injury, such as encephalopathy, cerebrovascular or cardiovascular events, pulmonary edema, renal injury, or aortic dissection. These patients require urgent evaluation and hospitalization.
Is accelerated hypertension the same as hypertensive urgency?
Malignant hypertension and accelerated hypertension are both hypertensive emergencies, with similar outcomes and therapies. Accelerated hypertension is defined as a recent significant increase over baseline BP that is associated with target organ damage.
When should you go to ER for high blood pressure?
“The American Heart Association states that a reading of 180/110 or greater requires immediate medical attention. If you take this reading two times in a row, five minutes apart, then you must head to the nearest ER,” says Dr. Meier.
What if my blood pressure is 160 110?
Normal pressure is 120/80 or lower. Your blood pressure is considered high (stage 1) if it reads 130/80. Stage 2 high blood pressure is 140/90 or higher. If you get a blood pressure reading of 180/110 or higher more than once, seek medical treatment right away.
Is 160 blood pressure high?
normal: less than 120/80 mm Hg. pre-hypertensive: systolic between 120-139 or diastolic between 80-89. stage 1 hypertension: systolic 140-159 or diastolic 90-99. stage 2 hypertension: systolic 160 or higher or diastolic 100 or higher.
What does it mean when you have a headache with hypertensive urgency?
Persons with hypertensive urgency may experience severe headache, shortness of breath, nosebleed, or anxiety. 1 With hypertensive emergency, the clinical presentation will depend on the particular organ that is undergoing injury, in addition to other symptoms, such as headache.
How long does it take for BP to drop in hypertensive urgencies?
Hypertensive urgencies may be treated in an outpatient facility with oral antihypertensives; treatment consists of a slow lowering of BP over 24 to 48 hours. 10 A reduction in BP of no more than 25% within the first 24 hours has been suggested. 10 Adjusting current medication regimens to improve adherence or increasing the doses of current agents may be a sufficient management approach. 11 However, additional agents may be necessary to attain desired results. Follow-up with the primary care provider within a week of the episode is necessary. 11
What are the risk factors for hypertensive crisis?
Subtherapeutic treatment regimens, nonadherence, and drug-induced etiologies have been attributed to its development. 1,3,5,6 Being African American, elderly, male, and lacking a primary care physician have been identified as major risk factors for the development of hypertensive crisis. 7,8 High grades of obesity, hyper tensive heart disease, increased number of BP medications, and history of somatoform disorders have been identified as contributing factors; however, these factors should be studied further before concluding that they can increase the risk for development of a hypertensive crisis. 5
What is the role of pharmacists in the management of hypertensive crises?
Pharmacists can play an integral role in the prevention and management of hypertensive crises. Proper patient education that includes the importance of medication adherence can help prevent the development of hypertensive urgencies.
What is hypertensive urgencies?
In contrast to hypertensive emergencies, hypertensive urgencies are characterized by an acute and critical increase in blood pressure without signs or symptoms of acute hypertensive target organ damage.
How long does it take for blood pressure to be lowered?
In these patients, blood pressure should be lowered within 24 to 48 hours in order to avoid hypertensive target organ damage. In general, hospitalization is not required, and oral antihypertensive therapy usually is sufficient.
What is hypertensive emergency?
Hypertensive emergencies include those conditions in which new or progressive severe end-organ damage is present and a delay in appropriate therapy might result in permanent damage, progression of complications, and a poor prognosis.
Is hypertensive urgency a hypertensive emergency?
A hypertensive urgency should be distinguished from a hypertensive emergency. Although the distinction may not always be obvious, certain guidelines may help the clinician determine which therapeutic approaches are most appropriate for each patient. Hypertensive emergencies include those conditions ….
Definitions
- Approximately 74 million people in the United States have hypertension, defined as a systolic blood pressure (BP) 140 mmHg or a diastolic BP 90 mmHg on at least two occasions.1,2 A severe, rapid elevation in BP is considered a hypertensive crisis. There are inconsistencies in the definition and the nomenclature of this condition. In addition, there is not an exact BP reading th…
Symptoms
- Patients presenting with hypertensive crisis typically have had either chronically elevated BP or may be completely unaware that they have hypertension. Subtherapeutic treatment regimens, nonadherence, and drug-induced etiologies have been attributed to its development.1,3,5,6 Being African American, elderly, male, and lacking a primary care physician have been identified as ma…
Signs and symptoms
- Persons with hypertensive urgency may experience severe headache, shortness of breath, nosebleed, or anxiety.1 With hypertensive emergency, the clinical presentation will depend on the particular organ that is undergoing injury, in addition to other symptoms, such as headache.
Diagnosis
- A rapid but thorough assessment must be performed in order to differentiate between urgency and emergency. The clinician should inquire about use of all medications, including OTC and herbal therapies, and illicit drug use. Medication adherence, including time of last dose, should be evaluated in all patients previously diagnosed with hypertension. BP should be confirmed in bot…
Treatment
- Hypertensive urgencies may be treated in an outpatient facility with oral antihypertensives; treatment consists of a slow lowering of BP over 24 to 48 hours.10 A reduction in BP of no more than 25% within the first 24 hours has been suggested.10 Adjusting current medication regimens to improve adherence or increasing the doses of current agents may be a sufficient managemen…
Availability
- Labetalol and esmolol have been available for years and are preferred in most conditions.3 Nitroglycerin and sodium nitroprusside have also been widely available, but their use is limited primarily to individuals with myocardial ischemia and acute pulmonary edema or aortic dissection, respectively. The third-generation agent, clevidipine, represents the first agent for hypertensive e…
Pharmacology
- Captopril: The angiotensin-converting enzyme inhibitor (ACE-I) captopril has been used in oral and sublingual forms for the treatment of hypertensive urgency. Doses ranging from 6.25 to 50 mg have been reported in the literature.11,14-16 An initial effect is seen within approximately 5 to 15 minutes of administration, reaching a maximum reduction of BP within 30 minutes.11,14-16 Th…
Side effects
- Clonidine: The centrally-acting, alpha2-agonist clonidine has been used for hypertensive urgencies. Doses ranging from an 0.1 to 0.2 mg loading dose followed by 0.05 to 0.1 mg every hour until desired BP is reached, or the maximum dose of 0.8 mg is reached, have been reported in the literature.10,11 Clonidine has an onset of action of 15 to 30 minutes, and the reported dur…
Medical uses
- For hypertensive emergencies, reported dosing regimens for IV labetalol include a loading dose of 20 mg followed by 20 to 80 mg doses repeated every 10 minutes until desired BP is attained, or the loading dose can be administered followed by a 1 to 2 mg/min continuous infusion; all regimens have a total effective dose of 300 mg.15 IV labetalol has an onset of action of 2 to 5 m…
Prevention
- Pharmacists can play an integral role in the prevention and management of hypertensive crises. Proper patient education that includes the importance of medication adherence can help prevent the development of hypertensive urgencies. Additionally, pharmacists can assist in the selection of drug therapy that is cost-effective and has relatively few adverse effects, thus reducing the po…
Resources
- 1. National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. August 2004. www.nhlbi.nih.gov/guidelines/ hypertension/jnc7full.pdf. Accessed October 10, 2010. 2. American Heart Association. Heart Disease & Stroke Statistics2010 Update. Dallas, TX: American Heart As…