Day #265 Hypertensive Emergency

Today we discussed a case of a patient from a marginalized social status with severe hypertension, decreased level of consciousness and seizure.

The issue of possible cocaine intoxication came up. A review of the cardiovascular consequences of cocaine use is presented here.

The management of hypertensive emergencies also was discussed. In general, with the exception of aortic dissection, the goal is to lower the blood pressure by ~25% of the mean arterial pressure in minutes to hours, and then achieve control of the blood pressure over the next days.

Options include intravenous labetolol (caution in catecholamine excess states like cocaine and pheochromocytoma) and nitrates like nitroglycerin (NB tachyphalaxis, not 1st line in aortic dissection) or nitroprusside (NB cyanide accumulation if renal failure or greater than 24h use, not 1st in aortic dissection).