Hypertensive urgency

• BP >=180/120 with NO symptoms except possibly isolated headache
• Manage with oral meds, follow up in hours to days
• Nifedipine IR 10 mg PO usually causes BP to drop within 10-20 minutes, may then switch to extended release

 

Hypertensive emergency

• BP>=180/120 with symptoms
  • visual changes (retinal hemorrhages/exudates, papilledema)
  • malignant nephrosclerosis (hematuria, proteinuria, ARF)
  • cerebral edema
  • SAH
  • signs of elevated ICP (headache, nausea, vomiting, altered LOC, seizures, coma)
• Manage immediately with parental meds
  • Labetalol 20 mg IV push over 2 minutes; followed by doses up to 80 mg q10min; total cumulative dose not to exceed is 300 mg.
  • OR
  • Nitroprusside infusion
  • OR
  • Nicardipine infusion

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The Compendium platform was created by David Kwinter, MD, CCFP(EM).