Hypertensive Emergencies

[Simusid]

I'm a newbie Basic. I bring my cuff/scope to work to practice taking BPs on my co-workers. Most of my friends are late 40's early 50's and I've seen some prehypertension and a few that were on the high side (above 160).

Today I did a friend and found his to be 200+/108. He has no outward symptoms or complaints. I would ordinarily just say something general like "I think that's high, maybe you should call your doctor". My question is, what would the numbers have to be, along with any other factors, for you to say "this is an emergency, we need to do something right now"?

 

[medichopeful]

I'm a newbie Basic. I bring my cuff/scope to work to practice taking BPs on my co-workers. Most of my friends are late 40's early 50's and I've seen some prehypertension and a few that were on the high side (above 160).

Today I did a friend and found his to be 200+/108. He has no outward symptoms or complaints. I would ordinarily just say something general like "I think that's high, maybe you should call your doctor". My question is, what would the numbers have to be, along with any other factors, for you to say "this is an emergency, we need to do something right now"?

200+/108? I'd say that's definitely a "call your doctor" BP, unless it normally runs that high or they have a known condition that makes that happen. I might even go as far as to say that is an emergency, depending on other conditions.

 

[JPINFV]

Definition

Hypertensive emergencies are severe elevations in BP, often higher than 220/140 mm Hg, complicated by clinical evidence of progressive target organ dysfunction. These patients require immediate admission and BP reduction (not necessarily to normal ranges) to prevent or limit further target organ damage. Examples include hypertensive encephalopathy, intracranial hemorrhage, acute myocardial infarction, acute left ventricular failure with pulmonary edema, dissecting aneurysm, acute renal failure, and eclampsia of pregnancy. Immediate admission to a monitored unit and parenteral antihypertensive therapy are indicated. It is the clinical state of the patient—in particular, the degree of and/or progression of target organ damage—–that defines a hypertensive emergency and not the absolute level of blood pressure.

Severe hypertension (urgencies) are marked elevations of BP, usually higher than 180/110 mm Hg. Evidence of target organ damage is often present, but nonprogressive and manifesting symptoms may include headache, shortness of breath, and pedal edema. Management in the emergency department (ED) with oral agents is suitable, depending on the individual's presentation, and follow-up within 24 to 72 hours is recommended. In many cases, with blood pressure higher than 180/110 mm Hg, patients present without clinical symptoms and have no clinical evidence of target organ damage. If untreated, they may be initiated on a two-drug regimen or an existing treatment regimen may be modified. Emotional distress or nonadherence with prior treatment are often at fault. These patients do not require BP reduction to normal and, after brief observation in the emergency room, can be discharged, with follow-up scheduled within 3 to 7 days.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/hypertensive-crises/

 

[juxtin1987]

The first questions i would want to know is, do you know if you typically have high blood pressure and when was the last time you visited your physician. If the Pt has chronic high bp, which could be caused by a number of different reasons, they may or may not be aware of it. Depending on his answers my reaction and comments would differ drastically.

1. I haven't seen a doctor in 10 years (its not that uncommon) but i remember them telling me before that i had high blood pressure.
-"Go See a doctor when you can and he may put you on some medication for to keep your BP at a more adequate level"

2. I saw the doctor yesterday for a post op follow up and my BP was 122/74
-"Sit down i'm driving and dont say no..." (We're going to the Emergency Room incase you were wondering)

3. I know i have high blood pressure, the doctor wanted me to take a prescription to control it but this companies insurance sucks and i can't really afford it.
-"Cool :censored::censored::censored::censored:, run what ya brung"

The important thing to remember is asymptomatic vs symptomatic as well as diagnosed problem vs undiagnosed problem. Many people just have elevated BP's they may be aware of it they may not, it may be indicative of a potentially life threatening presentation or it may not.

While you're checking BP's on all your co-workers, be sure to auscultate lung sounds you'll thank me later for having practiced this before you get in the field.

 

[street_shark]

I'm a newbie Basic. I bring my cuff/scope to work to practice taking BPs on my co-workers. Most of my friends are late 40's early 50's and I've seen some prehypertension and a few that were on the high side (above 160).

Today I did a friend and found his to be 200+/108. He has no outward symptoms or complaints. I would ordinarily just say something general like "I think that's high, maybe you should call your doctor". My question is, what would the numbers have to be, along with any other factors, for you to say "this is an emergency, we need to do something right now"?

damn, do they know their bps are that high??

 

[41 Duck]

They do now!


Later!

--Coop

 

[rmellish]

if they are asymptomatic all the ER would do is refer the patient to their primary care provider. My understanding of the current practices is a slow reduction in BP, over weeks, usually a trial of lisinopril or another ace inhibitor if my understanding is correct.

So, assuming his pressure was what you say it was, and it was undiagnosed HTN, it would not be treated as an emergency per se.

Diagnosed but mismanaged HTN (due to insufficient or incorrect med dosing or pt noncompliance) with a pressure that high isn't particularly unusual if asymptomatic.

Symptomatic HTN is treated differently of course.

 

[Jeffrey_169]

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/hypertensive-crises/

I agree with this post. It really would depend upon a few other factors. Is it chronic and known? or new onset and previously unknown? Is this a relative hypertension? Did he/ she just get finished an exhaustive exercise routine, or have they been relaxed for a while? Is there a known cause for it? (ie. extreme stress).

The emergent hypertensive pt. is the patient who is symptomatic, new onset, or your gut tells you so.

This is the simplest answer I can give. I hope it helps.

 

[PrincessAnika]

also, in a non-symptomatic pg, i would recheck in 5min time, after sitting and resting (what was he doing before the bp check? anything strenuous could throw the reading off, not that those numbers are something to blow off, but running up 4 flights of steps would send my BP through the roof, and i'm not out of shape, KWIM?) and to make sure i was correct with my reading. regardless, i would tell this person to contact their dr immediately, if asymptomatic, if symptomatic i would either take to ER or call 911 depending on symptoms.

 

[LucidResq]

I once saw a healthy-ish (meaning no medical hx but obese) 18 yo male with some crazy BP while working at the amusement park. He was an employee, and his boss made him come in because he looked like crap. I can't remember what it was... think it was like 190 something over 110 something. He was c/o of a headache but not much else. ECG was NSR and everything else was pretty normal.

The medic assessed him and really wanted him to be transported to the ER, but he called his mom and she didn't want him to. Mom came and picked him up, and the medic, who has like 15 years field experience and is awesome, could only stress that she took him to his MD ASAP.

One of the perks of working at the amusement park with employees - I saw him a few weeks later and he told me he saw his PCP who was trying to figure out what to do with him. BP was still elevated, but not as crazy as it was when we saw him.