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Discussion

Hypertension in ED

Hi, guys...just looking for some ed here :)

I know that you guys usually stabilize then send to the floor when in HTN crisis. I work PCU and usually will get them in 190's/100's. So I call for orders if nothing appropriate has been ordered yet, no big deal (as long as not 200's/110's, which almost got sent up. I begged for something to be given before transport, was too high and not CVA [CVAs we have BP parameters] so was given metoprolol IV before being sent to me).

My question is this, what is the rationale for not dropping BPs too quickly? How long (few hours, days, etc) does it usually take a person to stabilize that is considered appropriate? I have had patients w/high BPs take the gamut of meds and still high after a few days. Recently had a male whose BP finally lowered enough on my second shift (had been 200's/100's to 190's/100's previous day, finally got him down to 160s/90s on my second day there) after multiple calls to PCP for meds (never did manage to get any prn, but at least they kept adding stuff). My concern, also, would be, after hypertensive crisis passes and all meds on board and building up, too fast a drop/addition of meds could lead to bottoming out if patient dc'd too soon on new meds, etc?

Any views/advice? Thanks.

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    • Featured Replies

    If someone has been living with a high BP their body is used to it. Other than taking them out of the CVA/bleed zone we bring pressures down slowly so their body can acclimate again. So at each stage of the process they are evaluated for dizziness, kidney function, heart and lung issues. BP meds will affect heart function as well, and the patient may need investigations related to that.

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    • Author

    I hear ya. We have had high bp patients get very sleepy d/t some of the bp meds, lowering bp's, hr going down (but usually not).

    Had one poor 53 y/o female who developed dementia d/t uncontrolled bp issues per the doc. Was very sad.:crying2:

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    • Author

    Thanks for the site, LunahRN. Love the info :)

    We follow similar guidelines with our CVAs, who go to the neuro stroke unit.

    I was more wondering about appropriate guidelines to lower bp in non-CVA patients (i.e. regular hypertensives, renal failure, CHFs, etc.), since a lot of times we on the floor may freak over a bp that is considered ok by ER personnel.

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    • Moderator

    LOL ... sorry, might help if I read a bit more closely! Still waking up. :D

    More info, this one on malignant HTN -- looks like they use the MAP more than the systolic or diastolic in that case, but still 25% in the first 24-48 hours ... http://emedicine.medscape.com/article/241640-overview#aw2aab6b6

    Not sure that's exactly what you're looking for, I know what you mean -- those "regular" HTN patients with those 190s...

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    • Author

    That is a good link, thanks LunahRN :) That is precisely the kind of info I am looking for...wanting to ensure that I understand what are considered good parameters for dropping bp's and what the rationale is.

    Good to know what bp's ok to transfer, but parameters and rationales for lowering over certain period of time also helpful. I had tried looking it up, but not much useful clinical information, so figured you all would have a better picture of what is what :)

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    More info, this one on malignant HTN -- looks like they use the MAP more than the systolic or diastolic in that case, but still 25% in the first 24-48 hours ... http://emedicine.medscape.com/article/241640-overview#aw2aab6b6

    .

    This is very timely today as I went to battle 2 patients who were both in the 260's systolic and ordered cardene gtt at the same time. Interestingly enough, my ED docs goal was a 30% reduction in like 1 hr.... :confused: He told me to bump up the cardene on the one b/c his SBP had dropped "only" 30 pts.

    thanks for the info.

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    Agree with above. Our goal is 20% in the first 24 hours, never more.

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