Hypertensive Crisis in an Era of Escalating Health Care Changes

Theresa P. Yeo; Sherry A. Burrell

Disclosures

Journal for Nurse Practitioners. 2010;6(5):338-346. 

In This Article

Evaluation of Hypertensive Crises

Successful management of a patient with severely elevated BP depends on the ability to immediately differentiate hypertensive urgency from hypertensive emergency,[20] as treatment is dependent on the presence or absence of target-organ involvement (Table 2). The initial evaluation begins with obtaining a targeted, but accurate previous medical history, including a history of HTN and CVD, usual medications taken, and previous episodes of hypertensive crisis. The BP should be taken in all extremities with an appropriately sized BP cuff, and pulses assessed in all extremities. Lung auscultation includes assessment for the presence of rales and pulmonary edema. It is essential to listen over both renal arteries for bruits, to perform a focused neurological and fundoscopic examination. Hypertensive retinal changes are classified using the Keith-Wagener-Barker System (Table 3).[28] A complete blood count (CBC), electrolytes, blood urea nitrogen (BUN), creatinine, urinalysis with specific gravity, plasma renin levels, catecholamine levels, and cardiac enzymes including troponins should be obtained on all patients. Imaging studies such as a chest radiograph (to assess heart size and presence of HF or pulmonary edema), head CT scanning (to assess for intracerebral hemorrhage or subarachnoid hemorrhage [SAH]), an EKG (electrocardiogram) (to look for evidence of acute MI, unstable angina, or left or right ventricular hypertrophy), and possibly an echocardiogram (to assess for global akinesis) are appropriate. While other diagnostic tests may be indicated depending on the patient's history, the BP must be addressed while awaiting the results of diagnostic testing.

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