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p. 332

Hypertensive crisis is defined as a diastolic blood pressure greater than

120 mm Hg. This disorder can be further classified as hypertensive

urgency or hypertensive emergency when there is evidence of acutely

progressive end-organ damage.

Case 16-1 (Question 1),

Table 16-1

Risk factors for the development of a hypertensive crisis include, but are

not limited to, medication nonadherence, cocaine use, and drug–drug

and drug–food interactions.

Case 16-1 (Question 1)

Hypertensive urgency can be treated with oral antihypertensive agents

including clonidine, labetalol, or captopril. Caution must be taken to

prevent rapid reductions in blood pressure.

Case 16-1 (Questions 2–6)

Table 16-3

The organs primarily affected as a result of a hypertensive emergency

are the central nervous system, eyes, heart, and kidneys.

Case 16-2 (Question 1)

Parenteral therapy should be used to manage hypertensive emergencies,

and therapeutic options are dictated by the affected organ(s) and

comorbidities. Mean arterial pressure should be reduced by no more

than 25% initially, then subsequently reduced toward a goal of 160/100

mm Hg, for most patients, during the next 2 to 6 hours. Gradually

reduce blood pressure to normal, for most patients, during the next 8 to

24 hours.

Case 16-2

(Questions 2, 3, 4, 5, 9, 10),

Case 16-3 (Questions 1–6),

Case 16-4 (Questions 1, 2),

Table 16-4, Figure 16-1,

Table 16-2

Nitroprusside, a therapeutic option for hypertensive emergencies, has

been associated with cyanide and thiocyanate toxicity, and monitoring is

required to minimize the risk of these toxicities, especially in patients

with renal impairment.

Case 16-2 (Questions 6–8)

The most commonly used agents for the management of postoperative

hypertension are nicardipine, nitroglycerin, nitroprusside, and labetalol.

Case 16-5 (Questions 1, 2, 3)

Management of aortic dissection requires prompt control of blood

pressure without increasing the force of cardiac contraction or heart

rate.

Case 16-6

(Question 1)

The term hypertensive crisis is defined as a diastolic blood pressure (DBP) greater

than 120 mm Hg.

1 These disorders are divided into two general categories:

hypertensive emergency and hypertensive urgency (Table 16-1). If these disorders

are not treated promptly, a high rate of morbidity and mortality will ensue.

2–5

The term hypertensive emergency describes a clinical situation in which the

elevated blood pressure (BP) is immediately life-threatening and needs to be

lowered to a safe level (not necessarily to normal) within a matter of minutes to

hours.