APT: Hypertension
This week we will be looking at hypertension and how to diagnose it from outpatient to hypertensive emergency inpatient. In preparation there is a quick 2 page graphic review of the JNC-8 guidelines. There is also a NEJM on intensive vs liberal BP control. As optional reading there is an article from AFP on the JNC8 guidelines.
Optional reading
Hypertension
Definitions:
Normal: SBP <120 and DBP <80
Elevated: SBP 120-129 and DBP <80
Stage 1 HTN: SBP 130-139 or DBP 80-89
Stage 2 HTN: SBP ≥ 140 or DBP ≥90
End Organ Damage
Brain - stroke sequelae, multi-infarct dementia
Eye- retinopathy, hemorrhage, papilledema
Heart - diastolic dysfunction, LVH, obstructive cardiomyopathy, HFpEF, coronary atherosclerosis, MI, HFrEF
Kidney- CKD, Albuminuria, reduced GFR, end stage kidney failure
Vascular - aortic aneurysm (ascending, descending), atherosclerotic occlusive disease with limb or organ ischemia, aortic dissection
Hypertensive emergency: BP >180/>120 with evidence of end organ damage
Special Considerations
IPH/SAH - SBP goal < 140 ASAP
Aortic dissection: SBP <120 ASAP
General principals:
1st Hour: decrease BP < 25%
4-6 hours: BP < 160/100
>24-48 hours: BP < 140/90
