Emergencias hipertensivas
Resumen
Definition
History and exam
Key diagnostic factors
- presión arterial (PA) >180/120 mmHg
- presencia de factores de riesgo
Other diagnostic factors
- síntomas neurológicos
- síntomas cardíacos
- exploración cardiopulmonar anómala
- exploración abdominal anormal
- oliguria o poliuria
- examen de fondo de ojo anómalo
- examen neurológico anómalo
Risk factors
- hipertensión tratada de manera inadecuada
- enfermedad renal crónica (ERC)
- estenosis de la arteria renal
- trasplante renal
- enfermedades del sistema endocrino con efectos hipertensivos conocidos
- embarazo
- edad avanzada
- etnia negra
- sexo masculino
- uso de drogas simpaticomiméticas
- farmacoterapia con efecto hipertensor conocido
- apnea obstructiva del sueño
- vasculitis y enfermedades del tejido conectivo
Diagnostic investigations
1st investigations to order
- bioquímica sanguínea
- hemograma completo (HC) con frotis
- análisis de orina con microscopía
- electrocardiograma (ECG)
- radiografía de tórax
Investigations to consider
- pruebas de función tiroidea
- pruebas de función hepática
- enzimas cardíacas
- N-terminal del pro-péptido natriurético tipo B (NT-proBNP) en el líquido pleural
- perfil de coagulación
- prueba de embarazo en orina o suero
- cribado toxicológico de orina
- exploración por angiografía por tomografía computarizada (ATC)
- ecocardiografía transtorácica (ETT)
- ultrasonido Doppler renal
- tomografía computarizada (TC) sin contraste de cabeza
- resonancia magnética (IRM) de cabeza
- actividad de la renina plasmática y nivel de aldosterona
- metadrenalina (metanefrina) en muestra puntual de orina o plasma
- cortisol libre urinario de 24 horas
- estudio del sueño
Treatment algorithm
hipertensión acelerada (maligna) o encefalopatía hipertensiva o hemorragia intracraneal
accidente cerebrovascular isquémico agudo
isquemia miocárdica/infarto de miocardio
insuficiencia ventricular izquierda o edema pulmonar
disección aórtica
daño renal agudo
estado hiperadrenérgico
hipertensión grave en el embarazo (preeclampsia y eclampsia)
Contributors
Authors
M. Lee Sanders, PhD, MD
Clinical Associate Professor
Division of Nephrology
University of Iowa
Iowa City
IA
Disclosures
MLS is an author of a reference cited in this topic.
Manish Suneja, MD, FASN, FACP
Clinical Professor
Division of Nephrology
University of Iowa
Iowa City
IA
Disclosures
MS receives royalties from McGraw Hill as the editor of DeGowin’s Diagnostic Examination and is an author of a reference cited in this topic.
Acknowledgements
Dr M. Lee Sanders and Dr Manish Suneja would like to gratefully acknowledge Dr Hector Ventura and Dr Madhavi T. Reddy, previous contributors to this topic.
Disclosures
HV declares that he has no competing interests. MTR is employed by Merck and owns stocks in Merck, and Johnson & Johnson.
Peer reviewers
Aparna Sundaram, DO, MBA, MPH
Physician Consultant
Preventive Medicine
Private Practice
Atlanta
GA
Disclosures
AS declares that she has no competing interests.
Ethan Cumbler, MD
Assistant Professor
Department of Internal Medicine
University of Colorado Health Sciences Center
Denver
CO
Disclosures
EC declares that he has no competing interests.
Michael Schachter, MB, BSc, FRCP
Department of Clinical Pharmacology
St Mary’s Hospital
Imperial College
London
UK
Disclosures
MS declares that he has no competing interests.
References
Key articles
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.Full text Abstract
American College of Obstetricians and Gynecologists. Practice bulletin no. 222: gestational hypertension and preeclampsia. Jun 2020 [internet publication].Full text Abstract
Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension the Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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