Hypertension

Melissa M. Wu Arjun Chanmugam

Classification Pathophysiology

Clinical.Eyalu.ati.On.and., Management Overview

MedicaLHistory

Physical ..Examination

Diagnostic. .studies

Types. p.fH.ypertensiye .Emergencies Hypertensiye Encephalopathy strokensyndromes AcutePulmonary.. .Edema AcMte...Coro„nary...Syndromes Aortic.. Dissection Renal.Failure

Preeclampsia ..aM.Eclampsia Childhood. ..Hypertensive... Emergencies

Selection .of. an.. AntihypertensiyeAgent Agents .for...Treatment of..Hype^rtensiye.„Emergencies Sodmm..NitroprHsside..Mpride) Labetalol

Esmolol

|ntrayenous..Nitroglycerin

Hydralazine

Trimethaphan

Agents .for.Treatment. of..Hype^rtensiye..yrgencies

Sublingual . . Nitroglycerin

Clonidlne Captopri!

Nifedipine

Promising ..New. .AntihypeMrtensiye..Agents Enalaprilat

Fenoldopam

Nicardipine

Losartan

Chapter.. References

Hypertension is considered one of the most important modifiable risk factors for cardiovascular disease and is the fourth most prevalent chronic medical condition in the United States.12 Up to 24 percent of the United States general adult population and 32 percent of African Americans may be affected by hypertension. 3

Overall morbidity and mortality rates, and, in particular, the risk of developing serious cardiovascular, renal, or cerebrovascular disease increase with poorly controlled blood pressure. Although the public has become more knowledgeable, only two-thirds of Americans with high blood pressure are aware of their diagnosis. Of greater concern is that nearly 75 percent of adult Americans with hypertension are not controlling their blood pressure to below 140/90 mmHg, and only half are taking their prescription medications as directed.13 Accordingly, elevated blood pressure is frequently encountered in many emergency department (ED) patients.

The primary responsibilities of emergency physicians in the approach to hypertensive patients are to recognize and treat true emergencies, to manage the complications of chronic disease, and to arrange the most appropriate follow-up for nonemergent cases. To fulfill these responsibilities, emergency physicians need to have an understanding of the definitions, pathophysiology, and pharmacotherapy of hypertension.

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