Hypertensive crisis: clinical presentation and management

Hypertensive Crisis

Reference (APA Style): Yeo, T.P., Burrell, S.A. (2010). "Hypertensive crisis in an era of escalating health care changes." The Journal for Nurse Practitioners. 6 (5): 338-346.

This article provides a tremendous amount of analysis into the medical condition known as hypertension, which contributes to hypertensive crises. The latter is a more severe and detrimental version of the former. Additionally, the latter is also stratified into both hypertensive urgency and hypertensive emergency.

The article is written in a format where it serves to provide crucial information about hypertension to those who will be treating patients afflicted with it -- Advanced Practice Nurses. The authors initiate the article with a fair amount of background information including those most likely affected with this malady (which largely includes the elderly, African-Americans, obese people, and those without health care) its rate of incidence, and the amount of money that is spent treating this condition on an annual basis. The authors examine the particulars associated with general hypertension and with hypertensive crises, and then spend the bulk of the article discussing myriad causes and forms of treatment for people in various stages of these conditions.

A fairly good portion of this manuscript details highly specific narcotic and medical treatment that is used to counteract this condition. The authors also discuss some other less conventional means of enacting hypertensive crises, such as through the usage of the narcotic cocaine. The article concludes by implying that an increase in medication related to blood pressure and hypertension can help reduce the rate of incidence of this condition and also make it more livable for those who already have it.

Bullet Points

There are distinct symptoms for hypertensive emergency (220/140 mmHg) and for hypertensive urgency. The former include dysarthria, shortness of breath, nocturia, chest pain and weakness.

Symptoms for hypertensive urgency (180/120 mmHg) include edema, epistasis, headaches, and patients who frequently are asymptomatic.

The drugs of choice that nurses can select from to treat hypertensive crises patients include ACE inhibitors, nicardipine, loop diuretics, fenoldopam, labetolol, and esmolol, among others.

Aortic dissections are a principle cause of severe hypertension.

The purpose of therapy for hypertensive emergency is to lower the mean arterial pressure by 25% of the initial blood pressure, at most, within a couple of hours -- practitioners do not want to reduce the mean arterial pressure too much.

The goal of therapy for hypertensive urgency is to decrease the patient's blood pressure over a period of 12 to 24 hours.