Hypertensive crisis
SBP> 210 mmhg or DBP>120 mmhg。 hypertensive emergency Hypertensive crisis SBP> 210 mmhg or DBP>120 mmhg。 hypertensive emergency 血壓上升合併Target organ damage 懷孕20周以上的婦女發生高血壓 (140/90)要考慮子癇前症。 Catecholamine分泌增加 Hypertensive urgency 血壓高於210/120 mmHg 無明顯target organ damage的病人。
Diagnosis 血壓的測量 適當的壓脈帶：寬度為所測肢體周長之40%，充氣部位長度為肢體周長的80% 使病人靜坐五分鐘後所測得之值 要跟病人平時的基準血壓作比較
Target Organ Damage 神經方面 severe headache, blurred vision, seizure, new onset focal sign, papillary edema 心肺方面 dyspnea, chest pain, palpitation, pulmonary rales, S3 Gallop 血管方面 chest pain, back pain, abdominal pulsatile mass, pulse disparity (左右手相差血壓>20 mmHg) 腎臟方面 尿量減少,血尿
Hypertensive encephalopathy MP elevated exceeds the limits of autoregulation( often MAP> 150~160 mmHg) Acute onset, and reversible Severe headache, N/V, may cons. change even coma, focal sign, decrease VA D/D: … Treatment: nitroprusside
Renal failure ARF or A on CRI Increase BUN, Cr, proteinuria, U/A: red cell or casts Tx: nitroprusside
Treatment Hypertensive emergency 靜脈注射之降血壓藥物在30~60分鐘之內將MAP降低20~25% 腦中風有不一樣的降壓標準外 各種病症，有不同的適用藥物下表請參見下表。 Disease Preferred medication Hypertensive encephalopathy nitroprusside Aortic dissection or aneurysm Labetalol (另esmolol+nitroprusside) Acute coronary syndrome Nitroglycerin CHF with acute pulmonary edema Nitorglycerin or nitroprusside Renal injury Nitroprusside Preeclampsia Hydralazine, MgSO4 Catecholamine secretion Phentolamine
Treatment Hypertensive Urgency 口服藥物降血壓藥物在24小時之內將血壓慢慢降下來 對於有高血壓病史的病患，需評估藥物史與服藥的順從性，重新開立之前病患所使用的高血壓藥物，並在24小時內將病患約回門診。 對於沒有高血壓病史的病患，是否需要在急診治療仍有爭議。若經過解釋病患能夠接受，沒有症狀的病人不需在急診治療，可以在48小時內將病人約回門診。
Protocol
Reference Tintinalli et al: Emergency Medicine: A Comprehensive Study Guide. 6th ed. 2004 Schaider et al: Rosen & Barkin's 5-Minute Emergency Medicine Consult. 3rd ed. 2007. Lippincott Williams & Wilkins. UpToDate, version 14.3, 2006 eMedicine, hypertensive emergencies, Christy McCowan, MD, MPH, FACEP, Last Updated: April 13, 2006