BloodPressure

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Say what? Hypertensive emergency has no universally accepted definition. Actual numbers are often used to define hypertensive emergency, though strictly speaking a hypertensive emergency is any elevation in blood pressure in the presence of end-organ dysfunction.1,2,3 Aggressively treating severe asymptomatic hypertension (very high blood pressure without clear end organ damage) is not indicated, not supported…  

Some physicians believe renal denervation is pretty much history. After all, back in January 2014, the biggest trial of renal denervation conducted by Medtronic failed spectacularly in being unable to lower blood pressure in patients with resistant hypertension six months following the procedure. Soon after that announcement and well before its merger with Medtronic, Covidien too pulled the plug on its OneShot renal denervation program citing slow market growth in Europe.  

Three leading groups of heart experts have issued updated guidelines that set blood pressure goals for people with heart disease.  

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  

This case was written by Dr. Martin Kuuskne from McGill University. Dr. Kuuskne is a PGY4 Emergency Medicine resident and one of the editors-in-chief at EMSimCases. Why it Matters This case highlights three important aspects of the management of a subarachnoid hemorrhage: Blood pressure control in an undifferentiated neurologic catastrophe Safe approaches to intubating a patient…  

Rapid blood pressure lowering to intensive or standard targets in a multicenter, randomized controlled trial showed no difference in death or major