Patient Hypertensive Emergency

Hypertensive emergency is an uncommon complication of hypertension and is defined as decompensation of brain, heart, or kidney function of severe hypertension. And High blood pressure, also called hypertension, can damage your blood vessels, heart and kidneys. This damage can cause a heart attack, stroke or other health problems.

Hypertensive emergencies encompass a spectrum of clinical presentations in which uncontrolled blood pressures (BPs) to impending end organ dysfunction. And it is a common disease encountered in dental setting. Its wide spreading, terrible consequences, and life-long treatment require an attentive approach by dentists. Malignant hypertension is defined as an elevated blood pressure complicated by papilledema. The actual pressure at which end-organ dysfunction ensues is variable, but with the  exception of pregnancy, this life threatening situation does not occur unless the diastolic pressure exceeds 115 to 130 mm Hg.

Pathophysiology Of Hypertensive
The pathogenesis of essential hypertension is multifactorial and highly complex. The kidney is both the contributing and the target organ of the hypertensive processes.
high blood pressure at the arteriole level overwhelms the normal autoregulatory mechanisms leading to dilatation, Tissue perfusion is compromised and resulting in areas of local ischemia.
Endothelial damage, fibrinoid necrosis within vessel walls, rupture of the vessel, and tissue edema result in a microangiopathic hemolytic anemia.
sensitivity of brain tissue to increases in pressure causes cerebral edema, further compromising cerebral blood flow.

1. Symptoms of hypertention
visual complaints,
and also change in mental status should be taken as evidence of encephalopathy.

Physical examination findings
Funduscopic examination may reveal flame hemorrhages, exudates, and papilledema.
Cardiopulmonary examination may reveal evidence of acute CHF.
Neurologic examination may demonstrate alterations in mental status ranging from confusion and lethargy to coma. Focal findings may result from encephalopathy alone or be the result of concomitant cerebral vascular ischemia or hemorrhage, a common complication with dire
Your medical history, to evaluate risk factors such as smoking or family history of high blood pressure.
Two or more blood pressure measurements. Measurements may be taken from both the left and right arms and legs and may be taken in more than one position, such as lying down, standing, or sitting. Multiple measurements may be taken and averaged.

Measurement of your weight, height, and waist.
consequences. Subarachnoid hemorrhage may be the result or the cause of malignant hypertension.
Management of hypertensive

Serum electrolyte panel. A serum electrolyte panel may reveal evidence of hypokalemia, present in 50% of patients with malignant hypertension.
Microangiopathic hemolytic anemia with schistocytes on peripheral smear is a common finding.
Pharmacologic agents. Oral agents are not useful in treating true hypertensive emergencies due to their delayed onset of action and the inability to closely titrate the medication based on effect.
Nicardipine is a calcium channel blocker with properties similar to those of nifedipine, except that it is not a negative inotropic agent and it can be given intravenously. The onset of action is 15 to 30 minutes and the duration of action is 40 minutes.
Nitroglycerin has a rapid onset of action, is also consistent over the dose range, and has a duration of minutes. In patients with hypertensive crisis complicated by angina or pulmonary edema, nitroglycerin is the drug of choice. The initial dose is 20 to 30 _ g/min and can be titrated up based on the response to therapy.
Sodium nitroprusside has a rapid onset of action, consistency of effect over the dose range, and a duration of effect of only 1 to 3 minutes. Cyanide or thiocyanate toxicity can develop in patients with hepatic or renal insufficiency and in those treated for more than 48 hours.
Benzodiazepines are useful for controlling the hypertension and other adrenergic symptoms of cocaine overdose.

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