Learning Objectives:

Students should be able to:

• Define hypertensive emergency and differentiate from hypertensive urgency, based on:
  • Blood pressure measurement
  • Detection of acute target organ injury
  • Association of co-morbid conditions
• List the common co-morbid conditions, and recognize the signs and symptoms, associated with malignant hypertension
  
• List common drugs or other products associated with elevated blood pressure.
• Describe components of a focused exam for the patient with malignant hypertension
• Identify abnormal ECG findings associated with the cardiac effects of malignant HTN, including:
  • Ischemia
  • Infarction
  • Left ventricular hypertrophy
• Identify clinical situations where non-hypertensive inpatients may have elevated blood pressure, and describe appropriate treatments.
• Identify clinical factors relevant to therapeutic management, including:
  • Preexisting chronic hypertensive state
  • Volume status of the patient
  • Concurrent antihypertensive treatment
  • Associated co-morbid conditions
• Describe the mechanism and time of action, routes of administration, starting dose, clinical indications and contraindications, and side effects of the following drugs in the treatment of malignant hypertension:
  • Nitrates: nitroprusside and nitroglycerine
  • Beta-blockers including labetalol
  • Hydralazine
  • Clonidine
• Describe the concept of blood pressure autoregulation and its relevance to the treatment of malignant hypertension.
• Describe the goals of treatment of the patient with malignant hypertension.
• Describe a management plan, including bed placement, diagnostic and therapeutic measures, for:
  • The non-hypertensive patient with elevated blood pressure
  • The patient with hypertensive urgency
  • The patient with malignant hypertension and aortic dissection.