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ASSESSMENT & COMPLICATIONS

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.

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.

TREATMENT

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.

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.

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