Multiprofessional Critical Care Review: Adult (2023)-2: Management of Hypertensive Crisis (Janice Zimmerman, MD, MCCM, MACP)

Video Transcription

Video Summary

In this video presentation, Janice Zimmerman discusses the management of hypertensive crisis. She emphasizes the importance of determining whether the patient's blood pressure needs to be lowered acutely and, if so, by how much. The answer to the latter question will determine the choice of medication. Zimmerman provides examples of different patient scenarios and asks viewers to identify which patient requires immediate blood pressure reduction. She then covers the different conditions associated with hypertensive emergencies, such as encephalopathy, intracranial hemorrhage, stroke, myocardial ischemia, heart failure, and acute renal insufficiency. Zimmerman also briefly mentions other conditions that can lead to hypertensive emergencies, such as excess catecholamine states and drug withdrawal. She discusses the goals of therapy, which include arresting and reversing organ injury while maintaining organ perfusion and avoiding complications. Zimmerman explains the concept of autoregulation in the renal, cardiac, and brain systems and how it impacts blood pressure management. She also outlines the factors to consider when choosing a medication, including coexisting conditions, the desired extent and rate of blood pressure reduction, and the pharmacology of different drugs. Zimmerman concludes the presentation by addressing specific scenarios and providing recommendations for blood pressure management in each case, including patients with hypertensive emergencies, strokes, aortic dissection, and perioperative hypertension. She also mentions that there is no evidence of benefit in treating asymptomatic hypertension and advises to examine the patient and consider other factors before initiating treatment.

Keywords

hypertensive crisis

blood pressure management

acute blood pressure reduction

hypertensive emergencies

organ injury

autoregulation

medication choice

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