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Post written by – Dr Andrew Lam SAAG Serum Albumin – Albumin of Ascitic Fluid High SAAG (>11g/L) Suggests that the cause of ascites is related to portal hypertension Causes: […]
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Hypertensive Emergencies
Dr Swapnil Pawar
Hypertensive Urgency
Severe Asymptomatic Hypertension | Hypertensive Urgency | Hypertensive Emergency | |
Blood Pressure | > 180/110 mmHg | > 180/110 mmHg | > 220/140 mmHg |
Symptoms (i.e. headache, dizziness) | Nil | Present | Present |
End Organ Dysfunction | Nil | Nil ACUTE end organ dysfunction, but moderate non-acute dysfunction may be present | Significant acute end organ damage |
Management | Monitor and reassess or oral medication | Oral medication | IV medication |
Aim for a reduction of systolic BP to below 180mmHg over a period of 1-2 days | Aim to reduce symptoms and reduce systolic BP to below 180mmHg over 2-3 hours | Aim to reduce BP within minutes to prevent end-organ damage, but no more than 25% in the first 2 hours |
Acute End Organ Damage:
Cardiovascular:
– Acute myocardial infarction
– Aortic dissection
Pulmonary:
– Acute pulmonary oedema
Neurological:
– Haemorrhagic stroke (intracerebral haemorrhage, subarachnoid haemorrhage)
– Hypertensive encephalopathy
Renal:
– Acute renal failure
Ophthalmological:
– Retinal haemorrhage
– Papilledema
Secondary Causes of Hypertension
Endocrine | ||
Condition | Diagnostic Investigations | Clinical Signs |
Thyrotoxicosis | Thyroid Function Tests | Heat tolerance, anxiety, weight loss, diarrhea |
Phaeochromocytoma | 24 hour urine fractionated metanephrines/catecholamines OR plasma fractionated metanephrines | Sweating, tachycardia, episodic headache |
Conn’s Syndrome (Primary Hyperaldosteronism) | Aldosterone to renin ratio (elevated) | Hypokalemia (muscle cramps, fatigue, weakness) |
Cushing’s Syndrome | Late night salivary cortisol
24 hour urinary cortisol Dexamethaosone suppression test |
Muscle wasting/weakness, adipose tissue redistribution (buffalo hump, central obesity), mood swings, osteoporosis |
Other | ||
Condition | Diagnostic Investigations | Clinical Signs |
Renal Parenchymal Disease | Urinalysis, EUC’s and further investigation based on clinical presentation to determine underlying cause of renal disease | Peripheral oedema, lethargy, anorexia, haematuria |
Obstructive Sleep Apnoea | Polysomnography | Daytime somnolence, snoring, morning headache |
Drug Induced | N/A | Use of corticosteroids, NSAID’s, anti-depressants or recreational drugs (cocaine, amphetamines, MDMA) |
Renal Artery Stenosis | Renal duplex US
CT Angiography |
Renal bruit, proteinuria, fluid overload |
Aortic Coarctation | Echocardiogram
CT Angiography |
Exercise intolerance, cold feet, chest pain, dyspnoea, radiofemoral delay, but often asymptomatic |
References:
Elliott, W.J., Varon, J. Evaluation and treatment of hypertensive emergencies in adults. UpToDate. Retrieved January 30, 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/evaluation-and-treatment-of-hypertensive-emergencies-in-adults
Textor, S. (2020). Evaluation of secondary hypertension. UpToDate. Retrieved January 30, 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/evaluation-of-secondary-hypertension
Electronic Therapeutic Guidelines. (2020) Urgent control of elevated blood pressure. eTG Complete. Retrieved January 30, 2021, from https://tgldcdp.tg.org.au.acs.hcn.com.au/viewTopic?topicfile=urgent-control-severe-bp-elevation&guidelineName=Cardiovascular&topicNavigation=navigateTopic
Dr Swapnil Pawar December 22, 2020
Post written by – Dr Andrew Lam SAAG Serum Albumin – Albumin of Ascitic Fluid High SAAG (>11g/L) Suggests that the cause of ascites is related to portal hypertension Causes: […]
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