Editing High blood pressure


== Causes of acute high blood pressure ==

* Drug overdose
** Cocaine, amphetamines
* Drug interaction
** MAO inhibitors, indirect-acting catechols, wine, cheese, ephedrine
** TCAs, direct-acting catecholes
* Drug withdrawal
** Abrupt withdrawal from antihypertensive agents
* Phaeochromocytoma
* Burns
* Pain

== Complications of acute high blood pressure ==

* Hypertensive encephalopathy
** Rare, unusual in hospitalised patients
** Vomiting developing over several days, headache (occipital or neck), lethargy, confusion
** Results from cerebral oedema
** Focal neurological deficits are uncommon

== Phone call ==

* Rate of rise, compared to previous
* Pregnant?
* Antidepressant interactions?
* Recreational drugs?
* Hypertensive emergency?
** Back and chest pain (aortic dissection)
** Chest pain (MI)
** Shortness of breath (pulmonary oedema)
** Headache, neck stiffness (subarachnoid haemorrhage)
** Headache, vomiting, confusion, seizures (hypertensive encephalopathy)

== Assessment ==

* Vital signs - BP in both arms, check cuff size
** Bradycardia and hypertension may indicate high intracranial pressure
* Exam
** Headache
** Chest pain - MI
** SOB - APO
** Back or chest pain - aortic dissection
** Unilateral weakness or sensory symptoms
**

== Management ==

* Immediately lower the BP in these situations: (aim 25% in the first hours, and cautiously thereafter)
** Eclampsia
** Aortic dissection
** APO resistant to other emergency treatment
** MI
** Catecholamine crisis
** Hypertensive encephalopathy
** Uncontrolled bleeding anywhere, including worsening vision secondary to retinal haemorrhage
* Otherwise acute lowering is not of proven benefit
* Avoid oral or sublingual agents which may have delayed onset and cause precipitous drops

[[Category:Peri-op medicine]]