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ASSESSMENT & COMPLICATIONS
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Hypertension may be due to poisoning with amphetamines and synthetic stimulants, anticholinergics, cocaine, performance-enhancing products (eg, containing caffeine, phenylephrine, ephedrine, or yohimbine), MAO inhibitors, and other drugs.
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Severe hypertension (eg, diastolic blood pressure greater than 105–110 mm Hg in a person who does not have chronic hypertension) can result in acute intracranial hemorrhage, MI, or aortic dissection.
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Treat hypertension if the patient is symptomatic or if the diastolic pressure is higher than 105–110 mm Hg—especially if there is no prior history of hypertension.
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Hypertensive patients who are agitated or anxious may benefit from a sedative (such as lorazepam, 2–3 mg intravenously) or an antipsychotic drug (eg, haloperidol or olanzapine). For persistent hypertension, administer phentolamine, 2–5 mg intravenously, or nitroprusside sodium, 0.25–8 mcg/kg/minute intravenously. If excessive tachycardia is present, add esmolol, 25–100 mcg/kg/minute intravenously, or labetalol, 0.2–0.3 mg/kg intravenously. Caution: Do not give beta-blockers alone, since doing so may paradoxically worsen hypertension in some cases as a result of unopposed alpha-adrenergic stimulation.