Post-Quiz: Hypertensive Urgency and Emergency Management

FM is a 42-year-old male (87 kg) who presents to the ED with severe headache and hypertension (212/122 mmHg). He has been diagnosed with high blood pressure in the past but is not currently on any medication. A stat head CT shows no sign of intracranial pathology. Labs are drawn and his BMP is normal, except for a SCr of 2.1. His baseline SCr was 0.8 a year ago, and he denies any history of renal dysfunction. Based on his current situation, which of the following represents the best initial goals for reducing FM’s blood pressure?

A 60-year-old female with a history of uncontrolled hypertension presents to the emergency department with a sudden onset of severe headache, nausea, and vomiting. Her blood pressure on arrival is 215/125 mmHg. A computed tomography (CT) scan of the head reveals an intracranial hemorrhage. Which of the following medications is most appropriate for initial treatment of this patient’s hypertensive emergency?

BL is a 78-year-old female (67kg) who arrives at the Emergency Department (ED) experiencing difficulty breathing and coughing up pink foam. She has a history of high blood pressure but hasn’t taken her prescribed medications (lisinopril and hydrochlorothiazide) for several days. BL believes her blood pressure escalated due to stress from her family and an unusual diet filled with rich foods, but her difficulty breathing worsened rapidly within the last couple of hours. Upon examination, her blood pressure is 220/146, RR 34, O2 saturation 86% on room air, and her work of breathing is visibly increased. The physician believes that BL has Sympathetic Crashing Acute Pulmonary Edema (SCAPE). The respiratory therapist places BL on BiPAP, and the physician asks for your recommendation regarding medication therapies. Which of the following is the most appropriate recommendation for BL?

A 65-year-old female with a history of uncontrolled hypertension presents to the emergency department with a sudden onset of severe chest pain radiating to the back. Her blood pressure on arrival is 210/115 mmHg. A computed tomography (CT) scan reveals a dissection of the ascending aorta. Which of the following medications is most appropriate for the initial treatment of this patient’s hypertensive emergency?

A 55-year-old patient with chest pain is admitted to the emergency department. His ECG results are consistent with an acute myocardial infarction. As part of the treatment plan, the medical team has decided to initiate nitroglycerin therapy. Before this, which of the following medications should be checked in the patient’s medication history to avoid potentially lethal interactions?

A 58-year-old male with a history of uncontrolled hypertension presents to the emergency department with a severe headache, blurred vision, and shortness of breath. His blood pressure on arrival is 220/130 mmHg. Further examination reveals papilledema on fundoscopy and bilateral crackles on lung auscultation. The patient’s past medical history includes type 2 diabetes mellitus and hyperlipidemia. He reports non-adherence to his antihypertensive medications. In managing this hypertensive emergency, which of the following medications is most appropriate for initial treatment?

A 58-year-old male with a medical history of chronic hypertension presents to the emergency department (ED) with a severe headache and blurred vision. His blood pressure is recorded at 220/130 mmHg. The ED provider decides to initiate treatment with a calcium channel blocker for a hypertensive emergency. Which of the following is the recommended initial dose for nicardipine?

A 55-year-old male with a history of uncontrolled hypertension presents to the emergency department with chest pain and shortness of breath. His blood pressure on arrival is 200/120 mmHg. An electrocardiogram (ECG) shows ST-segment elevation in leads II, III, and aVF, suggesting an inferior wall myocardial infarction. Based on the patient’s presentation, which of the following best defines a hypertensive emergency?

A 68-year-old female with a history of uncontrolled hypertension presents to the emergency department with severe headache, confusion, and blurred vision. Her blood pressure on arrival is 220/130 mmHg. A computed tomography (CT) scan of the head reveals a small intracerebral hemorrhage. Based on the patient’s presentation, which of the following is the main goal of treatment for hypertensive emergencies?

In the CLUE trial, what were the inclusion and exclusion criteria for the patients?