Thread by @akhadilkarMD

As a Cardiology fellow, we get a lot of consults for hypertensive urgency/emergency.

Part 4: Clinical Consequences of Hypertensive Urgency/Emergency

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1) Hypertensive Encephalopathy
- Cerebral edema is induced by markedly elevated blood pressures
- Dysregulation of auto-regulatory capabilities of the brain
- Characterized by headache, irritability, and altered mental status
- Treatment of choice: Nitroprusside/Labetalol

2) Reversible Posterior Leukoencephalopathy Syndrome (PRES)
- MRI may reveal white matter edema in the parito-occipital regions

3) Ischemic Stroke
- Elevated BP is thought to be protective from hypo-perfusion because of vasodilation in peri-ischemic regions
- Patients should not be treated unless BP > 220/120 or evidence of end-organ damage elsewhere (i.e. aortic dissection/myocardial ischemia)

4) Intracranial Hemorrhage
- Cerebral perfusion pressure = MAP - ICP (should have a cerebral perfusion pressure of around 60-80 mm Hg)
- Should consult Neurology and have ICP monitoring
- Nimodipine is considered the standard of care; can help prevent vasospasm

5) Aortic Dissection
- Type A: mortality rate of 1%/ hour in the first 48 hours unless medical therapy is instituted; need emergent surgery

- Type B: Anti-hypertensive therapy to reduce vascular resistance and shear force; goal should be SBP: 100-1110 and HR: 50-60

6) Cardiogenic Pulmonary Edema
- Best treated with sodium nitroprusside/nitroglycerin
- Goal should be to decrease the acute pressure overloa and afterload mismatch
- Patients can have improvement in dyspnea and hypoxia after BP is lowered
- Avoid CCB/BB in decompensated state

7) Myocardial Ischemia
- Preload, afterload, contractility, and HR determine myocardial O2 consumption
- Significantly elevated BP can rupture stable coronary plaques leading to MI
- Be careful with heparin in hypertensive urgency w/ increased risk of intracerebal bleeding

*Not to use for medical advice and always discuss with your fellow or attending*

These are some of the common consequences of hypertensive urgency/emergency. Be aware of the impact of elevated blood pressures on all the organs!