Very high BP ( SBP > 210, and DBP> 130) + end organ damage begins ( eg encephalo- -pathy, angina/MI/blurred vision etc)
Thera
Severe hypertension (often defined as systolic blood pressure > 180 mmHg and or diastolic blood pressure > 120 mmHg) can produce a variety of acute, life-threatening complications, which are considered hypertensive emergencies.
Those include:
- Hypertensive encephalopathy, stroke.
- Acute left ventricular failure, myocardial infarction / unstable angina, aortic dissection
- Progressive renal damage & Malignant hypertension.
Treatment: Initial goals of BP reductions: In hypertensive emergencies gentle controlled reduction not less than 160/110
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The initial aim of treatment in malignant hypertension and hypertensive encephalopathy is to lower the diastolic pressure about I0% in the first hour and additional l5% within 3 to 12 hours, but not less than 160/110. More aggressive antihypertensive therapy is both unnecessary and may reduce the BP below the auto -regulatory range, possibly leading to ischemic events (such as stroke or coronary disease). The only 2 exceptions for rapidly lowering of the blood pressure are aortic dissection and post-operative bleeding from the suture lines.
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Once the BP is controlled, the patient should be switched to oral therapy, with the diastolic pressure being gradually reduced to 85 to 90 mmHg over two to three months
Treatment: Initial goals of BP reductions: In hypertensive Encephalopathy
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The initial goal of therapy is to reduce the mean arterial blood pressure by no more than 25% within minutes to 2 hours or to a blood pressure in the range of 160-100/11O mmHg.
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This may be accomplished with IV nitroprusside, a short acting vasodilator with a rapid onset of action that allows minute to minute control of blood pressure. Parenteral labetalol & nicardipine are also effective in hypertensive encephalopathy. - then switch to oral