APT: Hypertension

This week we will be looking at hypertension, from diagnosis in the outpatient setting to management in the inpatient setting. Please check out the 2017 ACC HTN guidelines a NEJM article on intensive vs liberal BP control (Sprint Trial). There are additional resources below you may find helpful.

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Additional Resources

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

1. Brain - stroke sequelae, multi-infarct dementia

2. Eye- retinopathy, hemorrhage, papilledema

3. Heart - diastolic dysfunction, LVH, obstructive cardiomyopathy, HFpEF, coronary atherosclerosis, MI, HFrEF

4. Kidney- CKD, Albuminuria, reduced GFR, end stage kidney failure

5. 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