Managing Hypertension in the Emergency Department

Focus on the MAP: 

  • MAP is the only value measured by BP cuff 

  • Don’t be alarmed by a particular SBP 

  • MAP is mostly DBP 

What is the cause? Think of secondary HTN 

  • Sympathomimetic toxicity 

  • Pre - eclampsia 

  • Pulmonary edema 

  • Aortic dissection 

  • CVA 

  • Uncontrolled pain/agitation (urinary obstruction?) 

  • Pheochromocytoma 

  • Hyperthyroidism 

Primary HTN 

  • Patients with chronic hypertension have failure of cerebral autoregulation of their BP 

  • Probably concerned when the patient is above their baseline at about a MAP 120- 140 

 Are they symptomatic? Is there end organ damage? 

  • Headache 

  • Encephalopathy 

  • Pulmonary edema 

  • Chest pain/type 2 MI 

  • Acute kidney injury  

  • Microangiopathic hemolytic anemia 

If there is end-organ damage 

  • IV medications 

  • Admission 

  • Arterial line 

  • What’s your target BP:

  • Anything else you want to treat? Volume overload? 

  • Reduce BP (MAP) by 20% over first 1-2 hours