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^ Case Study Hypertensive Emergency

A 50-year-old woman is seen in the emergency department complaining of a severe headache, shortness of breath, and ankle edema. Her vision is blurry and her blood pressure is 200/140 mm Hg. A blood test reveals azotemia and proteinuria. A chest radiograph reveals an enlarged cardiac silhouette. Is this a hypertensive emergency, and if so what pharmacological treatment might be considered?

Answer: This patient appears to be have malignant hypertension and signs of congestive heart failure. The azotemia and proteinuria are signs of renal disease and often portend deteriorating renal function. The enlarged heart and ankle edema are signs of heart failure, as is the shortness of breath. The blood pressure is very high, and this should be treated as an emergency. With blood pressure this high and the ominous clinical signs, this patient needs to be hospitalized and receive drug therapy to lower the blood pressure. The physician in a case such as this would likely choose intravenous therapy to get control of the blood pressure quickly. Although there are a number of choices, sodium nitroprusside should be at the top of the list. Diazoxide is also a good choice. Nitroprusside has a rapid onset of action, within seconds of starting an infusion. It may benefit this patient to improve cardiac output by reducing afterload and preload. Other antihypertensives that could be considered in this situation are labetalol, a combined a- and p-blocker, and nicardipine, a calcium channel antagonist. An advantage of these agents is that they can be administered intravenously, and once the patient is stabilized, one can switch to an oral formulation.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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