Hypertensive Crisis: NCLEX Priorities
Hypertensive urgency vs emergency, target reduction rate, drug selection.
Hypertensive crisis is BP >180/>120. The NCLEX distinguishes urgency (no target organ damage) from emergency (organ damage present).
Urgency vs emergency
Urgency, BP elevated, no organ damage. Oral meds, slower reduction over 24-48h. Emergency, BP elevated + organ damage (encephalopathy, MI, stroke, aortic dissection, pre-eclampsia). IV meds, ICU.
Reduction rate
Do not drop BP too fast, risk of cerebral hypoperfusion, stroke. Target: reduce MAP by ~25% in first hour, then to ≤160/100 over 2-6 hours.
IV drugs
Nicardipine, labetalol, esmolol, clevidipine common. Nitroprusside for emergency reduction (caution cyanide toxicity). Hydralazine in pregnancy.
Frequently asked
Aortic dissection, drug choice?
Beta-blocker first (esmolol, labetalol) to reduce shear stress, then add vasodilator.
Pre-eclampsia HTN, drug?
Labetalol, hydralazine, or nifedipine. Magnesium for seizure prophylaxis.
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