134 - Hypertensive Emergencies Demystified: A Brief Clinical Review

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 3 August 2021

⏱️ 44 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we provide a concise review of the diagnostic criteria and general treatment approach to patients with hypertensive emergencies.

Key Concepts

Hypertensive “urgency” is a misnomer - patients do not require immediate therapy and definitely should not receive IV therapy.
In most cases, the goal blood pressure in hypertensive emergencies is to decrease by no more than 25% in the first hour, achieve a BP of 160/100 in hours 2-6, then over the next 24-48 hours lower to a more normal blood pressure goal.
Labetalol is the preferred IV push antihypertensive UNLESS patients have acute heart failure, bradycardia, or possibly in patients with asthma/COPD.
Nicardipine is one of the most commonly used IV infusions for hypertensive emergencies. Most other continuous infusions are reserved for special types of hypertensive emergencies (e.g. nitroglycerin for pulmonary edema or acute MI, esmolol for aortic dissection).

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.2	And now on to the show. Welcome to Helix Talk episode 134. I'm your co-host, Dr. Kane.
0:35.5	And I'm Dr. Patel. And the title of today's episode is
0:38.5	Hypertensive Emergencies Demystified, a brief clinical review. So today we're talking about
0:44.3	the diagnostic criteria, definitions, and general treatment approach for patients with
0:49.5	hypertensive emergencies. So Dr. Cain, for a topic like this, I know you spice up things by giving us a case,
0:58.0	so let's hear it.
0:59.0	Sure.
1:00.0	So this is kind of a typical patient that I would see in the ICU setting with hypertensive
1:06.0	emergency.
1:07.0	So this is a 55-year-old male who came in with stroke symptoms.
1:10.0	So he has right-sided facial droop,
1:12.0	right-sided arm and leg weakness, slurred speech. And they say, yep, he has an acute
1:16.6	ischemic stroke. Unfortunately, his last no normal time was 12 hours ago. So he's outside of our
1:22.6	typical TPA window or Altaplace window of three to four and a half hours. Today, his blood pressure is
1:28.9	260 over 150 millimeters of mercury and his heart rate is tachycardic at 110 beats per minute.
1:35.9	So given that sky high blood pressure, clearly the next question is going to be, what is the most
1:41.0	appropriate approach to treat that patient's hypertension.
1:45.3	And Dr. Kane, this is definitely your alley because my eye just went a little bit wide.
	...

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