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Internal Medicine

Hypertensive encephalopathy (HE)

Hypertensive encephalopathy (HE) is general brain dysfunction due to significantly high blood pressure (> 200/130 mmHg)

  • HYPERTENSIVE EMERGENCY

 

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Main complications of persistent high blood pressure | Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain

 


Aetiology

Causes of severe persistent hypertension:

  • Kidney failure
  • Rapidly stopping blood pressure medications
  • Pheochromocytoma
  • People on a monoamine oxidase inhibitor (MAOI) who eats foods with tyramine
  • Pregnancy (eclampsia)

Pathophysiology

Hypertensive encephalopathy:

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Vaughan, C. J., & Delanty, N. (2000). Hypertensive emergencies. The Lancet, 356(9227), 411–417. https://doi.org/10.1016/S0140-6736(00)02539-3

Clinical features

  • Headache
  • Vomiting
  • Trouble with balance
  • Confusion

Complications

  • Seizures
  • Posterior reversible encephalopathy syndrome
  • Bleeding in the back of the eye

Management

Parenteral agents:

  • Nitroprusside (arteriolar and venous dilator)
  • Nicardipine (arteriolar dilator)
  • Clevidipine (short-acting dihydropyridine CCB)
  • Labetalol (α- & β-adrenergic blocker)
  • Fenoldopam (peripheral dopamine-1 receptor agonist)

Oral agents:

Slower onset of action and an inability to control the degree of BP reduction (limited use in the therapy of hypertensive crises)

  • Sublingual nifedipine
  • Sublingual captopril
  • Liquid nifedipine

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