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Hypertensive Emergencies

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					Hypertensive Emergencies




        Malcolm A. Lewis
  Consultant Paediatric Nephrologist
Q1. Is the patient hypertensive?

• High normal or pre-hypertension 90th to 95th centile

• Stage 1 hypertension 95th centile to 99th + 5 mmHg

• Stage 2 hypertension > 99th centile + 5 mmHg

• Severe hypertension > 95th centile + 20 mmHg
Casual BP centiles - Boys
Casual BP centiles - Girls
Rule of thumb
But;
But;
And;
Q1. Is the patient hypertensive?

• High blood pressure

      – Properly taken

      – Repeatedly taken

      – Checked manually

Or;

• High blood pressure with symptoms
Q2. Is the patient symptomatic?
Symptoms in hypertension
PRES   (Posterior reversible encephalopathy syndrome)
Q3. Is there an evident cause?
Causes of hypertension
Approach to the patient with hypertension
 Approach to the patient with hypertension



• H

• E

• A

• T
 Approach to the patient with hypertension



• History         • Duration of symptoms if any

                  • Previous medical history
• E               • Family history

                  • Drug history
• A

• T
 Approach to the patient with hypertension



• H               • Height and Weight

                  • Cutaneous stigmata
• Examination     • Four limb BP

                  • Oedema / fluid overload
• A
                  • Cardiomegaly
• T
 Approach to the patient with hypertension



• H               • FBC, biochemical profile

                  • Urinalysis
• E               • Renal tract US

                  • ECG, echo if possible
• Assessment
                  • CXR
• T
Approach to the patient with hypertension



• H

• E

• A

• Treatment
        Treatment of severe hypertension


•   Does the patient have obstructive uropathy?

    –   Urinary catheter

    –   Nephrostomy
        Treatment of severe hypertension


•   Does the patient have obstructive uropathy?

•   Is the patient fluid overloaded?

    –   Diuretics
        Treatment of severe hypertension


•   Does the patient have obstructive uropathy?

•   Is the patient fluid overloaded?

•   Is there another known cause for hypertension?

    –   Treat or adjust targeted therapy
       Treatment of severe hypertension


•   Does the patient have obstructive uropathy?

•   Is the patient fluid overloaded?

•   Is there another known cause for hypertension?

•   If none of the above discuss and consider

    antihypertensive treatment.
Treatment of severe hypertension
Treatment of severe hypertension
Treatment of severe hypertension

				
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posted:7/18/2013
language:Latin
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