【高血压精品英文课件】高血压急症 hypertensive emergencies

Hypertensive Emergencies,Amy Staples, MD, MPH UNM Department of Pediatrics,Outline,Measuring BP Definition of Hypertension Etiology of hypertension in kids When to treat How to treat,Clinical Quiz,11 yo girl with a sinusitis, HA and BP 124/83 5 yo boy with rash, abd pain, joint pain, tea colored urine and BP 117/81 16 yo athletic boy in clinic for sports PE BP 132/84,HTN Treat _ _ _ _,Clinical Quiz,3 yo girl with NF, alert and playful; BP 125/772 yo girl with nephrotic syndrome admitted for albumin/lasix due to anarsca, with severe HA and seizure, BP 119/76; on admit 93/52,HTN Treat_ _ _,Outline,Measuring BP Definition of Hypertension Etiology of hypertension in kids When to treat How to treat,Measuring accurate BPs,Cuff too small high reading Cuff too big OK reading or no reading (usually not falsely low) Lower extremities - Normally, BP is 10 to 20 mmHg higher in the legs than the arms Prefer arm if at all possible Right arm for comparison with standards,Cuff Size,Bladder width > 40% of mid-arm circumference. Bladder length 80-100% of arm circumference.,A. Ideal arm circumference B. Range of acceptable arm circumferences C. Bladder length D. Midline of bladder E. Bladder width F. Cuff width,Oscillometric Devices,Measure mean arterial pressure (MAP) and calculates SBP and DBP The algorithms used are proprietary and NOT standardized Results can vary widely and they do not always closely match BP values obtained by auscultation These machines must be calibrated regularly,Manual vs. Automatic,Manual is the gold standard Oscillometric measurements preferred in infants and ICU settings ONLY All high readings should be confirmed with a manual,Confirming High BPs,Repeat BP in both arms and one leg (both not usually necessary) Repeat 3 times to assure accurate Dx of HTN requires elevated BPs on 3 separate occasions,Disappearance of “HTN” with Repeated Measurement,Outline,Measuring BP Definition of Hypertension Etiology of hypertension in kids When to treat How to treat,New BP Normals,4th report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents Correlates with the JNC 7 Uses new growth parameter data from NHANES,Definitions,Normotensive Average SBP and DBP 90th but 120/80) Hypertension Average SBP and/or DBP >95th percentile for age, sex and height on 3 separate occasions Stage 1: 95th-99th percentile + 5 mmHg Stage 2: >99th percentile + 5 mm Hg,How to use the tables,Need: Age, gender, height percentage BP charts,7 yo boy Ht 75%tile,http:/www.cc.nih.gov/ccc/pedweb/pedsstaff/bptable1.PDF,50% 99/58 90% 113/73 95% 119/80 99% 127/88,BP tables for Infants,*Task Force on Blood Pressure Control in Children. Report of the Second Task Force on Blood Pressure Control in Children1987.Pediatrics.1987;79:125(PR),Urgency vs. Emergency,Urgency severely elevated BP with no current evidence of secondary organ damage, although if left untreated, target organ injury may result imminently Decrease BP Soon Emergency severely elevated BP with evidence of target organ injury Decrease BP Immediately Target organs CNS, heart, kidney, eye,Constantine and Linakis, Pediatric Emergency Care, 2005,Severe Hypertension,“Hypertension that represents a threat to life or to the function of vital organs”OR Severe hypertension is when your blood pressure goes up too!,Adelman, et al. Pediatric Nephrology, 2000,Outline,Measuring BP Definition of Hypertension Etiology of hypertension in kids When to treat How to treat,Etiology of Hypertension,Constantine and Linakis, Pediatric Emergency Care, 2005,Miscellaneous Causes,Endocrine Hyperthyroid Pheochromocytoma Elevated ICP/CNS disease Drug use (cocaine, ecstasy) Medication (abrupt withdrawal) Exercise Traction Hypovolemia,Overall,15-20% Essential Hypertension 80-85% Secondary Hypertension 60-80% Renal 8-10% Renovascular 2% Coarctation,Outline,Measuring BP Definition of Hypertension Etiology of hypertension in kids When to treat How to treat,Which hypertensive patients need immediate treatment?,Severe HTN Malignant HTN - >30% above 95% Moderate Severe HTN - >99% with target organ damage Symptomatic HTN Target Organ Damage,Complications of Severe HTN,Retinopathy 27% Encephalopathy 25% LVH 13% Facial palsy 12% Visual changes 9% Hemiplegia 8%,Deal, et al. Arch Dis Child, 1992,Clinical Signs of Malignant HTN,Eyes Retinal hemorrhages, exudates and papilledemaMalignant Nephrosclerosis ARF, Hematuria, ProteinuriaHypertensive Encephalopathy Headache, nausea, vomiting Restlessness, confusion seizures, coma MRI (T2-weighted images) ; Edema of the white matter of the parieto-occipital regions: posterior leukoencephalopathy,Eyes,Papilledema, blurred optic disk, hemorrhages,Hypertensive Encephalopathy,Failure of autoregulation,Flynn, Ped Neph 2009; 24, 1101-1112,Shifted baseline,Hypertensive Encephalopathy,Headache, nausea, vomiting Restlessness, confusion seizures, coma Posterior Leukoencephalopathy,