Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Assessing Chest Pain |Hypertension |Hypertension in Pregnancy |Malignant Hypertension |Preeclampsia, Eclampsia and HELLP |Acute Heart Failure |Chronic Heart Failure
β οΈ Key Point: Patients with malignant hypertension may be volume-depleted due to pressure-induced natriuresis. Careful IV saline replacement may be required alongside antihypertensive therapy.
| Grade | Features |
|---|---|
| I | Mild arteriolar narrowing/sclerosis |
| II | Marked narrowing, AV nipping |
| III | Narrowing + haemorrhages, cotton-wool spots |
| IV | All above + papilloedema |
π― Treatment Goal: Reduce MAP by β€20β25% in first few hours. Targets: SBP <200 mmHg or <180/120 mmHg depending on scenario. π Always seek expert input in emergencies.
| Emergency | Timeline & Target BP | First-Line | Alternative |
|---|---|---|---|
| HTN crisis + retinopathy/AKI/MAHA | Hours; MAP β20β25% | Labetalol | Nitroprusside, Nicardipine |
| Hypertensive encephalopathy | Immediate; MAP β20β25% | Labetalol | Nicardipine |
| Aortic dissection | Immediate; SBP <110 | Labetalol Β± Nitroprusside | Metoprolol + Nitroprusside |
| Pulmonary oedema | Immediate; MAP 60β100 | Nitroprusside + diuretic | Nitroglycerine |
| ACS | Immediate; MAP 60β100 | Nitroglycerine | Labetalol |
| Ischaemic stroke (>220/120) | 1h; MAP β15% | Labetalol | Nicardipine |
| Cerebral haemorrhage | 1h; SBP <180, MAP <130 | Labetalol | Nicardipine |
| Ischaemic stroke + thrombolysis | 1h; BP <185/110 | Labetalol | Nicardipine |
| Cocaine/XTC intoxication | Hours; SBP <140 | Benzodiazepines β Phentolamine | Nitroprusside |
| Pheochromocytoma crisis | Immediate | Phentolamine | Nitroprusside |
| Peri-op HTN (CABG) | Immediate | Nicardipine | Nitroglycerine |
| Post-craniotomy HTN | Immediate | Nicardipine | Labetalol |
| Severe preeclampsia/eclampsia | Immediate; BP <160/105 | Labetalol + MgSO4 | Nifedipine, Nicardipine |