Difference between revisions of "Hypertension (main)"

(Clinical Features)
(Evaluation)
Line 10: Line 10:
  
 
==Evaluation==
 
==Evaluation==
 
+
{{Asymptomatic hypertension evaluation}}
  
 
==Management==
 
==Management==

Revision as of 11:49, 4 December 2016

Background

Categorization of Hypertension[1]

^Many emergency physicians do not use the diagnosis of "hypertensive urgency," but utilize instead only hypertensive emergency (signs of end organ dysfunction) or asymptomatic hypertension (all others)

Clinical Features

Differential Diagnosis

Hypertension

Evaluation

Asymptomatic hypertension

  • Urine pregnancy in all women of child-bearing age (consider preeclampsia if positive)
Routine screening for acute target organ injury (e.g. creatinine, UA, ECG) is NOT required (Level C)[2]
In select patient populations, screening of creatinine may identify injury that affects disposition (Level C)[2]

Suggested algorithm:

  • <120 diastolic
    • No screening ED workup --> home with outpatient treatment
  • >210 systolic or >120-130 diastolic
    • Chem 7 (creatinine) --> home with outpatient treatment if no evidence of acute renal failure
      • "No other diagnostic screening tests (e.g. UA, ECG) appear to be useful"[2]

Management

Disposition

  • Hypertensive emergency --> admission
  • Otherwise, normally discharged home with a follow up appointment with the primary care physician

References

  1. Levy PD. Hypertensive Emergencies — On the Cutting Edge. EMCREG - International. 2011. 19-26.
  2. 2.0 2.1 2.2 Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department with Asymptomatic Elevated Blood Pressure. ACEP Clinical Policies Subcommittee on Asymptomatic Hypertension. Annals of Emergency Medicine. 2013; 62(1):59-63.