High blood pressure
Causes of acute high blood pressure
[edit | edit source]- 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
[edit | edit source]- 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
[edit | edit source]- 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
[edit | edit source]- 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
[edit | edit source]- 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