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Hypertensive Urgency and Emergencies (INC Aortic Dissection)

August 12, 2018 By Dr. G, PharmD

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Hypertensive Urgency SBP >=180 or DBP >=110 No target organ damage Can lower over several hours or days.  May not even admit. Can use oral agents like captopril, clonidine, nifedipine or labetalol.Hypertensive Emergency SBP >=180 or DBP >=110 Target organ damage (vision, neuro, kidneys, heart, etc) Avoid sudden or drastic decrease in BP Always admit. Decrease MAP 20-25% within the first hour.  Use IV agents like sodium nitroprusside, nitroglycerin, hydralazine, enalaprilat, fenoldopam, nicardipine, clevidipine, esmolol or labetalol.

Aortic Dissection:

  • In aortic dissection, you must decrease blood pressure rapidly to 100-120, pulse 60-70.
  • Use labetalol or esmolol alone or in combination with nicardipine, clevidipine or nitroprusside.
  • Avoid hydralazine in aortic dissection.
  • If giving a beta-blocker, give before the vasodilator because vasodilators can cause rebound tachycardia.

Filed Under: Cardiology Tagged With: aortic dissection

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020