HYPERTENSION


Assessment & Complications
Hypertension may be due to poisoning with amphetamines, anticholinergics, cocaine, ephedrine-containing performance-enhancing products, monoamine oxidase (MAO) inhibitors, and other drugs.
Severe hypertension (eg, diastolic blood pressure > 105–110 mm Hg in a person who does not have chronic hypertension) can result in acute intracranial hemorrhage, myocardial infarction, or aortic dissection. Patients often present with headache, chest pain, or encephalopathy.
Treatment
Treat hypertension if the patient is symptomatic or if the diastolic pressure is greater than 105–110 mm Hg—especially if there is no prior history of hypertension.
Hypertensive patients who are agitated or anxious may benefit from a sedative such as lorazepam, 2–3 mg intravenously. For persistent hypertension, administer phentolamine, 2–5 mg intravenously, or nitroprusside sodium, 0.25–8 mcg/kg/min intravenously. If excessive tachycardia is present, add propranolol, 1–5 mg intravenously, or esmolol 25–100 mcg/kg/min intravenously. Caution: Do not give β-blockers alone, since doing so may paradoxically worsen hypertension.


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