Cardiovascular Critical Care II

Withdrawal syndromes (e.g., clonidine or β-antagonists)

Drug-drug/drug-food interactions (e.g., monoamine oxidase inhibitors and tricyclic antidepressants,

antihistamines, or tyramine)

Spinal cord disorders

Pheochromocytoma

Pregnancy

Asymptomatic, markedly elevated blood pressure: Repeat BP measurement using proper technique to

confirm result. Address underlying acute conditions that may be contributory (e.g., pain, anxiety, etc.). If

chronic hypertension is present, it may be reasonable to resume with or without intensification of home

antihypertensive program. Over-agressive treatment may occur if not appropriately differentiated from

hypertensive emergency.

Goal Time

BP Target

< 60 min

↓ DBP by 10%–15% or MAP by 25% with goal DBP ≥ 100 mm Hg

2–6 hr

SBP 160 mm Hg and/or DBP 100–110 mm Hg

6–24 hr

Keep above BP goals (hours 2–6) during first 24 hr

24–48 hr

Outpatient BP targets

aSee compelling conditions in the text that follows.

A 25% reduction in MAP during the first hour is targeted to maintain cerebral perfusion (blood

flow autoregulation) and to not precipitate ischemia, which has been found with >50% reductions

If neurologic function deteriorates during the initial 25% decrease (or during subsequent lowering),

therapy should be discontinued or a reduced percent decrease should be targeted (N Engl J Med

1990;323:1177-83).

Compelling conditions leading to unique treatment timing and goals:

Acute aortic dissection

left ventricular contraction as a function of time).

target of management.

(within 5–10 minutes).

ii.

Acute ischemic stroke

pressure to the brain.

pressure (ICP): CPP = MAP − ICP.