2. Definitions:
• Hypertension:
• Stage I: 140-159/90-99
• Stage II: >160/100
• Hypertensive Urgency:
• Systolic BP >180 or Diastolic BP >120 in the absence of
end-organ damage
• Hypertensive Emergencies:
• SBP >180 or DBP>120 in the presence of end-organ damage
4. Malignant hypertension
Acute ↑ of BP (hypertensive crisis) in a patient with
underlying hypertension
or sudden onset of HTN in a previously normotensive
individual
with irreversible organ damage
SBP >180 or DBP >120
Damage :
diffuse necrotizing vasculitis
arteriolar thrombi
fibrin deposition in arteriolar walls (kidney, brain, retina, and other organs)
5. Malignant hypertension
Damage :
diffuse necrotizing vasculitis
arteriolar thrombi
fibrin deposition in arteriolar walls (kidney, brain, retina, and …)
Fibrinoid Necrosis
progressive retinopathy (arteriolar spasm, hemorrhages, exudates, and
papilledema)
renal function with proteinuria
microangiopathic hemolytic anemia
encephalopathy
Hx:
use of MAO inhibitors , OCP,cocaine, amphetamines ,…
12. s
↓ ↓ of BP, under the lower limit of autoregulation = cerebral ischemia (also
Renal and Coronary blood flows )
13. initial Goal
↓ MAP : 25% of HTN (160/100–110 mmHg)
in minutes to 2 h
IV nitroprusside, labetalol,nicardipine
14. preeclampsia
5–7% of pregnant women
after 20 weeks of gestation
new onset of hypertension (BP>140/90 mmHg)
+
proteinuria (>300 mg/24 h) (organ damage)
Eclampsia = onset of seizures (convulsions) in a woman with pre-eclampsia
15. Severe preeclampsia
BP >160/110 mmHg
proteinuria >5 g/24 h
CNS dysfunction (headaches, blurred vision, seizures, coma)
Renal dysfunction (oliguria or creatinine > 1.5 mg/dL)
pulmonary edema
hepatocellular injury (ALT > 2-fold the upper limits of normal)
hematologic dysfunction (platelet count < 100,000/L or DIC)
placental dysfunction (oligohydramnios or severe IUGR)
HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)