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Severe HTN ( hypertention) فشار خون بالا

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Severe HTN ( hypertention) preeclampsia

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Severe HTN ( hypertention) فشار خون بالا

  1. 1. Emergent & urgent Hypertension Reference: Harrison 2012, Chapter 247 ‫خدا‬ ‫نام‬ ‫به‬
  2. 2. Definitions: • Hypertension: • Stage I: 140-159/90-99 • Stage II: >160/100 • Hypertensive Urgency: • Systolic BP >180 or Diastolic BP >120 in the absence of end-organ damage • Hypertensive Emergencies: • SBP >180 or DBP>120 in the presence of end-organ damage
  3. 3. Hypertensive Emergencies:  Hypertensive encephalopathy  Malignanthypertension  Stroke  Myocardial infarction/unstable angina  Acute left ventricular failure  Aortic dissection  Adrenergic crisis  Postoperative hypertension  Preeclampsia/eclampsia of pregnancy
  4. 4. Malignant hypertension  Acute ↑ of BP (hypertensive crisis) in a patient with underlying hypertension  or sudden onset of HTN in a previously normotensive individual  with irreversible organ damage  SBP >180 or DBP >120  Damage : diffuse necrotizing vasculitis arteriolar thrombi fibrin deposition in arteriolar walls (kidney, brain, retina, and other organs)
  5. 5. Malignant hypertension  Damage :  diffuse necrotizing vasculitis  arteriolar thrombi  fibrin deposition in arteriolar walls (kidney, brain, retina, and …)  Fibrinoid Necrosis  progressive retinopathy (arteriolar spasm, hemorrhages, exudates, and papilledema)  renal function with proteinuria  microangiopathic hemolytic anemia  encephalopathy  Hx: use of MAO inhibitors , OCP,cocaine, amphetamines ,…
  6. 6. Normal
  7. 7. Autoregulation in brain
  8. 8. s  ↓ ↓ of BP, under the lower limit of autoregulation = cerebral ischemia (also Renal and Coronary blood flows )
  9. 9. initial Goal  ↓ MAP : 25% of HTN (160/100–110 mmHg)  in minutes to 2 h  IV nitroprusside, labetalol,nicardipine
  10. 10. preeclampsia  5–7% of pregnant women  after 20 weeks of gestation new onset of hypertension (BP>140/90 mmHg) + proteinuria (>300 mg/24 h) (organ damage)  Eclampsia = onset of seizures (convulsions) in a woman with pre-eclampsia
  11. 11. Severe preeclampsia  BP >160/110 mmHg  proteinuria >5 g/24 h  CNS dysfunction (headaches, blurred vision, seizures, coma)  Renal dysfunction (oliguria or creatinine > 1.5 mg/dL)  pulmonary edema  hepatocellular injury (ALT > 2-fold the upper limits of normal)  hematologic dysfunction (platelet count < 100,000/L or DIC)  placental dysfunction (oligohydramnios or severe IUGR)  HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)
  12. 12. treatment  Mild preeclampsia  Bed rest  Severe preeclampsia  delivery + labetalol(IV) Nifedipine hydralazine ACEI (-) Magnesium sulfate
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Severe HTN ( hypertention) preeclampsia

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