HTN

Use the MAP

• MAP is what the automated Bp cuff is actually measuring (whereas the systolic and diastolic Bp are estimated using proprietary algorithms)

• MAP may be most closely related to the risk of hypertensive emergency

• The best way to titrate antihypertensive drugs in a logical fashion is to target a specific MAP.

• Hypertensive Emergency = Severe HTN (MAP of at least >140 mm) + End-organ damage (aki, mi, ape, encephalopathy) 

• What is causing the hypertensive emergency?

  • Sympathomimetic drugs/meds, CNS, SCAPE, dissection, preeclampsia, renal, overload, pain/anxiety, nonadherence to meds (withdraw from clonidine)

• Thing to consider obtaining for eval: EKG, Bedside Sono (LVH, APE, volume status, dissection), basic labs, UA, trop, Utox, CT Head

• 1) Treat Pain/agitation 

• 2) Withdraw volume (diuresis/dialysis)

• 3) IV Hypertensives

4) Oral Hypertensives (when pt has been stable on IV hypertensives for several hours