On this episode we’ll teach you to dominate hypertensive urgency and severe hypertension (HTN) in the clinic, the ER, or on the hospital wards. The Curbsiders offer you this delicious serving of knowledge food so you can manage high blood pressure (BP) without making the same egregious errors that we made during our more formative years.
Of note, The Curbsiders are guestless for this episode. Guestless? Is that a word? Our guest for this episode was supposed to be Dr. Wallace Johnson, a Cardiologist, and expert on HTN from the University of Maryland. He did a fantastic job, but, unfortunately, technical difficulties caused us to lose any useable audio. Our sincerest gratitude and deepest apologies to Dr. Johnson. Nevertheless, we pressed on and used one of our own, the illustrious Dr. Paul Williams, as our expert guest.
Goal: Listeners will become proficient in the appraisal of severe hypertension/ hypertensive urgency and employ safe and practical management strategies.
By the end of this podcast listeners will:
The Curbsiders report no relevant financial disclosures, but hope to become successful enough to display an absurd list of disclosures in the future.
1:38 Rapid fire questions
03:45 Triage of patient with severe HTN
05:05 Case example HTN in office
07:05 Does HTN cause a headache?
08:30 Workup of severe HTN in the office
10:20 Stuart discusses HTN and headaches
11:30 In office treatment of blood pressure
15:50 Stuart discuss HTN emergency at normal BP
17:00 Acute treatment of HTN in ER
18:10 Approach to the inpatient with HTN
20:50 Choice of agent for inpatient HTN
23:23 Italian study of HTN crisis in the ER
24:20 Outcomes in asymptomatic patients with severe HTN
26:15 Sleep apnea and HTN
27:10 Natural history of untreated severe HTN
29:10 Take home points
Links from the show:
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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I think the hypertensive urgency portion of JNC 7 document you list is on page 18 (not the list page), unless my computer is showing it differently.
This helped me realize I need to document more in my chart that the patient doesn't have signs of end organ damage (CVA, MI, CHF) when I see someone in the office with really high blood pressure. This will support my decision to send them home. I need to have my medical assistant follow up on them. Thanks for emphasizing this. I don't think I am going to blow the dust off my ophthalmoscope and attempt to look at the back of the eye....sorry Paul.