Definition, Pathophysiology, epidemiology,causes and sign and symptoms of hypertension with management of hypertensive crisis

1. Management Of
Hypertensive Crisis
Phar 660
Zeinab Noormonavar
01/03/21

2. Did You Know That The Pressure Of Life
Enters Into The Blood Stream And
Causes High Blood Pressure?

3. Outline
Recall the pathophysiology, diagnosis, symptoms, epidemiology, causes and types
of hypertension
Recommend an appropriate treatment plan
Discuss management of hypertensive crises
Learn the different drugs used
Provide appropriate patient education

4. Definition Of Hypertension
• According to WHO: Hypertension, also known as high or raised blood pressure, is a
condition in which the blood vessels have persistently raised pressure.
• Blood pressure is created by the force of blood pushing against the walls of blood
vessels (arteries)Arterial BP (mm Hg) as it is pumped by the heart.
1) Systolic BP (SBP): Achieved during Cardiac Contraction (peak value)
• Represent the Cardiac Output
• First Korotkoff sound
2) Diastolic BP (DBP): Achieved during ventricular relaxation
• Represent peripheral vascular resistance of blood vessels
• Fifth or last korotkoff sound
 Blood pressure (BP) = Cardiac output (CO) x Systemic vascular resistance
(SVR)

5. Epidemiology
HTN is the leading cause of cardiovascular disease and premature death worldwide.
1.13 billion people worldwide have hypertension.
1 in 4 men and 1 in 5 women have hypertension.
Findings of recent studies in Lebanon have showed that HTN affects one-third of
the Lebanese population and an additional 30% are pre-hypertensive.
 prevalence in Lebanon: 31.2%
75% of the Lebanese aged >65 years have HTN.
60% of hypertensive patients are receiving medical therapy.

6. Types Of Hypertension
• Systolic 130 to 139 mmHg OR
• Diastolic 80 to 89 mmHg
Stage 1
• Systolic at least 140 mmHg OR
• Diastolic at least 90 mmHg
Stage 2
• Blood pressure is consistently elevated by office readings
but does not meet diagnostic criteria for hypertension
based upon out-of-office readings.
White coat
• BP values are markedly elevated
• SBP > 180 mm Hg AND/OR DBP > 120 mm Hg
• Also Known as: Emergency (with acute target organ
damage) and Urgency (without acute target organ
damage)
Crises

7. Pathophysiology

8. Signs &
symptoms
Severe
headache
Severe
chest
pain
Nausea
&
vomiting
Shortness
of breath
Severe
anxiety
Seizure
Un-
responsiv
eness

9. Tests to
be
done
EKG
Conventional
chest
radiography
Urinalysis
Serum
electrolyte &
creatinine
Cardiac
biomarkers
CT scan
MRI

12. Non Pharmacological Treatment
Weight
loss
DASH
diet
Avoid
stress
Sodium
reduction
Potassium
supplementation
Avoid
alcohol
Medication
adherence

18. Patients with hypertensive crises
exhibit severe elevations in BP
that can lead to extensive
morbidity and even mortality if
the hypertension is improperly
managed.
The appropriate therapeutic
approach in a given case
depends on the patient's clinical
presentation.
Patients with hypertensive
urgency lack end-organ damage
and can be treated with oral
medications that gradually
reduce BP to goal over a period
of several hours to several days.
Hypertensive emergencies, on
the other hand, require intense
monitoring in an ICU setting
and IV therapy with the goal of
halting the progression of end-
organ damage.
Through their expertise in
retrieving medication histories
and their knowledge of
pharmaco therapeutic options,
pharmacists can have a positive
influence on the care of patients
with hypertensive crises.
Conclusion

20. Pathophysiology Algorithm

21. DRUG TO BE USED
Parenteral Therapy
1. Labetalol: Renal dysfunction
2. Esmolol: Multi organ failure, CHD
3. Nicardipine: IV infusion or Bolus
4. Clevidipine: CI egg/soy allergy
5. Sodium nitroprusside: prevent
fluctuation
6. Hydralazine:
7. Fenoldopam: Concurrent renal disease
Oral Therapy
1. Isradipine
2. Clonidine: cause rebound hypertension
3. Nifedipine
4. Minoxidil: SE: hirsutism, severe
hypotension, Na/water retention
pericardial effusion  Furosemide

23. References
1) https://www.who.int/health-topics/hypertension#tab=tab_1
2) https://www.uptodate.com/contents/management-of-severe-asymptomatic-
hypertension-hypertensive-urgencies-in-
adults?search=hypertension%20crisis%20treatment&topicRef=3840&source=see_
link
3) https://www.uspharmacist.com/article/management-of-hypertensive-crises
4) www.ahajournals.org
5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606848/