Hypertensive Emergencies - Dr. Godfrey

Asx HTN <220/120 without complaints. HTN urgency >220/120 w/o end organ damage. HTN emergency >220/120 + end organ damage. When to treat asx HTN? If BP >165/105 + Cr >2, start two agents. or >220/>120 without any dysfunction, two agents. If 140-165: Controversial, but at the very least, tell the pt and Fast-track them. *Social intervention*.

  Blood-Pressure Drugs Don’t Increase Coronavirus Risk

It is safe to continue taking your blood-pressure medications, researchers said.

  Why managing blood pressure matters during COVID-19 pandemic

Managing hypertension matters in the fight against COVID-19 too. What’s known about COVID-19 so far suggests that people with pre-existing conditions such as hypertension, diabetes and heart disease can experience severe complications when infected with SARS-CoV-2, the virus that causes COVID-19.

 Hypertensive emergency

#1 most common mistake = overdiagnosis of hypertensive emergency among patients with scary high Bp but no target organ damage. This isn't a hypertensive emergency...

 Mean Arterial Pressure (MAP)

Mean Arterial Pressure = 1/3(SBP) + 2/3(DBP). MAP = [2(diastolic Bp) + Systolic Bp]/3 - A MAP ≥ 60 mmHg is believed to be needed to maintain adequate tissue perfusion. A MAP ≥ 65 mmHg is recommended in patients with severe sepsis and septic shock by the Surviving Sepsis Campaign Guidelines Committee.

 Under Pressure!: Acute Blood Pressure Management in Emergency Medicine

Acute blood pressure management in the emergency department is in my mind one of the most confusing and controversial topics in emergency medicine. Different blood pressure targets have been proposed for a variety of emergency medical and traumatic conditions. Guidelines are made to benefit the majority of patients with each condition but it is always necessary to consider individual factors such as age, preexisting uncontrolled hypertension and other comorbidities.

Guidelines on Blood Pressure Eased

The new hypertension recommendations say doctors should consider prescribing blood-pressure drugs to patients age 60 and over whose levels are 150/90 or higher. The previous threshold was 140/90.

Hypertension Management in Older and Frail Older Patients

The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population’s aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life.

Hypertension Treatment Guidelines Update

A suggested treatment protocol for moderate hypertension of >20 mm Hg above goal is: An ACE inhibitor or an ARB with a diuretic or a dihydropyridine (DHP) calcium channel blocker (such as amlodipine, felodipine, or nifedipine) combination. Start with a low dose and titrate upward.

The latest blood pressure guidelines: What they mean for you

High blood pressure, previously defined as 140/90 mm Hg or higher, is now defined as 130/80 mm Hg or higher. This change reflects the latest research that shows health problems can occur at those lower levels.

2017 Guideline for High Blood Pressure in Adults

The 2017 guideline is an update of the “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure” (JNC 7), published in 2003. The 2017 guideline is a comprehensive guideline incorporating new information from studies regarding blood pressure (BP)-related risk of cardiovascular disease (CVD), ambulatory BP monitoring (ABPM), home BP monitoring (HBPM), BP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension treatment and control, and various other important issues.

Hypertension: Is It Time to Replace Drugs With Nutrition and Nutraceuticals?

Many natural compounds in food, as well as certain nutraceutical supplements, vitamins, antioxidants, or minerals, can mimic drugs, functioning in a similar fashion to a specific class of antihypertensive medications. However, they may be less potent and take longer to work than the antihypertensive drug. When used in combination with other nutrients and nutraceutical supplements, though, the antihypertensive effect can be magnified.

First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity...

Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older.

International Society of Hypertension Global Hypertension Practice Guidelines

To align with its mission to reduce the global burden of raised blood pressure (BP), the International Society of Hypertension (ISH) has developed worldwide practice guidelines for the management of hypertension in adults, aged 18 years and older.

ACE Inhibitors vs ARBs for First-Line Hypertension Treatment

Angiotensin receptor blockers (ARBs) were found to be equally effective to angiotensin-converting enzyme (ACE) inhibitors for first-line treatment of hypertension; however ARBS may be less likely to cause adverse effects, according to the findings of a multinational cohort study recently published in Hypertension.

Choice of drug therapy in primary (essential) hypertension

The American Heart Association and the European Society of Hypertension/European Society of Cardiology (ESH/ESC), as well as various meta-analyses, all concluded that the amount of blood pressure reduction is the major determinant of reduction in cardiovascular risk in both younger and older patients with hypertension, not the choice of antihypertensive drug.

First‐line drugs for hypertension

Thiazides best first choice for hypertension... The treatment effect for first‐line ACE inhibitors was similar to low‐dose thiazides but less robust, and ACE inhibitors are more expensive than thiazides. First‐line low‐dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First‐line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality. First‐line high‐dose thiazides and first‐line beta‐blockers were inferior to first‐line low‐dose thiazides.

Blood pressure drugs work far better if taken at night, study shows

Taking blood pressure medication at bedtime rather than on waking halves the risk of events such as heart attack and stroke, a major study has revealed. Experts say the findings could potentially transform the way such medications are prescribed, but questions remain, not least why taking the medication at night has such a profound effect.

Blood Pressure Management in Adults

Hypertension is one of the most common conditions seen in primary care clinics and emergency departments (EDs). Frequently, patients are found to have asymptomatic hypertension and referred to EDs for management, despite the fact that rapidly lowering blood pressure is not necessary and may be harmful. Yet many clinics still refer these patients for emergent management.

Combination therapy at the start of hypertension treatment: pros and cons

This article will elaborate the pros and cons of a two-drug regime at the start of treatment in newly diagnosed hypertensive patients, and whether the benefits outweigh the potential risks.

Hypertensive crisis management in the emergency room time to change?

A rapid, marked and persistent rise in blood pressure (BP) levels above 180/120 mmHg is a clinical condition currently defined as hypertensive emergency or urgency in the presence or absence of acute signs of hypertension-mediated organ damage, respectively.

Less Popular Blood Pressure Medication Is the (Slightly) Safer Choice

Once a physician decides to prescribe medication to control a patient’s high blood pressure, the next decision — which one to choose — is complicated.

Two Types of Blood Pressure Medicine Prevent Heart Events Equally, but Side Effects Differ

People who are just beginning treatment for high blood pressure can benefit equally from two different classes of medicine – angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) – yet ARBs may be less likely to cause medication side effects, according to an analysis of real-world data published on July 26, 2021, in Hypertension, an American Heart Association journal.

Was it optimal to drop a diuretic as a first-line choice of drug treatment in the 2020 International Society of Hypertension Guidelines?

Modern hypertension guidelines are evidence-based in that they recommend medical treatments that have been proven effective in lowering blood pressure and preventing cardiovascular disease outcomes and death in randomised controlled clinical trials and/or in well-designed observational studies with large patient populations.