0071643192.pdf

ABI < 0.9 is seen in

claudication.

Diabetic patients may have a

paradoxically normal ABI due

to calcification and

noncompressibility in the

dorsalis pedis and posterior

tibial arteries.

Hypertension =SBP > 140 or

DBP > 90.

DIAGNOSIS

■ Suspect based on history and examination
■ Ankle brachial index <−0.9
■ Arteriogramis definitive.
■ Shows diffuse atherosclerosis, irregular cutoff, collaterals

TREATMENT

■ Risk-factor modification
■ Antithrombotic therapy (aspirin, clopidogrel, warfarin)
■ Immediate surgical intervention if limb-threatening ischemia
■ Stents or arterial bypass surgery
■ Wound care for ulcerations
■ Cessation of smoking =only effective therapy for Buerger’s

A 65-year-old male with a history of HTN treated with lisonopril and

atenolol presents with a 6-hour history of headache, vomiting, and pro-

gressive confusion. Initial BP is 220/130, and remains on repeat measure-

ment. Emergent head CT shows no hemorrhage. What is the goal for managing

this patient’s blood pressure?

Reduce MAP by 25% within 30—60 minutes with a titratable agent such as ni-

troprusside. Do not use oral agents because precise BP control is harder to achieve.

HYPERTENSION

HTN is defined as a SPB >140 or a DBP >90. HTN the is a major risk factor
stroke, heart disease, renal failure, vascular disease, and retinal disease.

The Joint National Committee on Prevention, Detection, Evaluation, and Treat-
ment of High Blood Pressure has stratified BP into categories (see Table 2.20).

ETIOLOGY

■ Essential (primary) hypertension comprises>90% of all cases of HTN.
Although no specific cause has been identified, most cases have a com-
mon end pathway of activation of the renin-angiotensin system.
■ Secondary hypertension: Underlying cause has been identified (see
Table 2.21).

In the ED, HTN can be classified as transient HTN, mild HTN, hypertensive
urgency (a historical term), or hypertensive emergency.

CARDIOVASCULAR EMERGENCIES

TABLE 2.20. Classification of Blood Pressure for Adults

CATEGORY SYSTOLIC DIASTOLIC

Normal < 120 and < 80

Prehypertension 120—139 or 80—89

Stage 1 HTN 140—159 or 90—99

Stage 2 HTN ≥160 or 100