HPT emergencies March 2009课件.pptVIP

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2017-08-21 发布于广东
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HPT emergencies March 2009课件.ppt

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HYPERTENSIVEEMERGENCIES Louis Muller 11 March 2009 Content Introduction Definitions Prevalence/morbidity/mortality Etiology pathophysiology Diagnosis Causes Differential diagnoses Workup Management Treatment Pharmacology IV Anti-hypertensives References Introduction Hypertension(HPT) very common Western soc. 50 mil. US – affected (world - approx. 1 billion people) Despite awareness + treatment still 30% adults unaware 40% known with HTN - not on treatment 60% on treatment BP not controlled to 140/90 mm Hg New data – shown incr. lifetime risk of HPT - incr. risk of CVS complications with “normal” BP levels Classification Joint National Committee (JNC – 7) introduced a new classification system for HTN – 2004 Normal – SBP120 and DBP80 Prehypertension – SBP 120-139 or DBP 80-89 Stage I hypertension – SBP 140-159 or DBP 90-99 Stage II hypertension – SBP 160 or DBP 100 Stage II HPT further divided into: Hypertensive urgency Hypertensive emergency Other Terminology Severely elevated BP (JNC VII) Defined as BP 180/120 “accelerated HPT” term used to describe individuals with chronic hypertension with associated group 3 Keith-Wagener-Baker retinopathy “malignant HPT” describe those individuals with group 4 KWB retinopathy changes + papilledema Definitions HPT emergency(crisis): Is characterized by a severe elevation in BP, complicated by evidence of impending or progressive target/end organ dysfunction VS HPT urgency: is a severe elevation in BP without progressive target organ dysfunction NB – these definitions do not specify absolute BP levels Conditions constituting evidence of EOD Hypertensive encephalopathy Intracerebral heamorrhage Stroke Head trauma Ischemic heart disease (most common) AMI Acute LVF with P/oedema Unstable angina Aortic dissection Eclampsia Life threatening arterial bleed Prevalence/ morbidity/ mortality Prevalence: With progress in anti-hypertensive