Hypertension - House Officer Guide

Last Updated on June 6, 2022

Definition

• Severe hypertension = persistent elevated SBP >180 mmHg and/or DBP >110 mmHg
• Hypertensive crises — Hypertensive urgency / Hypertensive emergency
• Hypertensive urgency = Severe HTN + grade III or IV retinal changes; without acute target organ damage
• Hypertensive emergency = Severe HTN + acute target organ damage

• Resistant hypertension = Uncontrolled HTN (>140/90 mmHg) with good medication adherence while on 3 – 4 anti-hypertensive agents (including a diuretic) in adequate doses

Causes of secondary hypertension

Management of Hypertensive Crises

Hypertensive Crises	Hypertensive Urgency	PRODUCT TWO
Initial management	• Rest in quiet room (no talking / active listening)
BP monitoring	• Initially check BP every 30 mins up to 2 hours • After starting anti-HTN, check BP every 30 mins for 1 hour
Target	25% reduction in BP over 24 hours; but not lower than 160/100 mmHg ===== 10 to 20 mmHg reduction in BP after: • Bed rest for 2 hours, OR • Initiation of anti-HTN	Acute heart failure • <25% within 1 hour, then • ≤160/100 mmHg over 2 - 6 hours • BP lowering until symptom resolution ACS • <25% within 1 hour, then • ≤160/100 mmHg over 2 - 6 hours Acute aortic dissection • SBP ≤120 mmHg // BP ≤120/80 mmHg AND HR <60 bpm within 1 hour Hypertensive encephalopathy • 20 - 25% within 1 hour AKI • 25% within 3 - 24 hours Pre-eclampsia / Eclampsia • SBP <140 mmHg within 1 hour Sympathetic crises / Phaeochromocytoma • Rapid BP lowering until symptom resolution
Oral anti-HTN	• Initiated after 2 hours of bed rest if no reduction in SBP Options: 1. T Captopril 12.5 mg stat then 1 - 2 hourly/PRN 2. T Nifedipine 10 mg stat then 1 - 2 hourly/PRN 3. T Labetalol 200 mg stat then 4 hourly/PRN
Parenteral anti-HTN	No role of parenteral anti-HTN

(i) Hypertensive Urgency

• Bed rest for 30 mins, then repeat BP

(ii) Hypertensive Emergency

• ssd

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