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Hypertensive urgency is a situation in which blood pressure must be lowered within a few hours. Severe perioperative hypertension is considered a hypertensive urgency. Hypertensive urgencies are managed with oral doses of fast-acting agents such as loop diuretics bumetanide [Bumex], furosemide [Lasix] ; , beta-blockers propranolol Inderal ; , metoprolol Lopessor ; , nadolol Corgard ; , angiotensin-converting enzyme inhibitors benazepril [Lotensin], captopril [Capoten], enalapril [Vasotec] ; , calcium antagonists dil.
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A 53-year-old man presented to the emergency room ER ; complaining of a burning sensation in his chest after eating a hot dog. The burning sensation, which occurred about one hour prior to presentation, was accompanied by some dizziness and lasted for approximately 30 minutes. The patient had a similar episode the day prior. Although the patient denied any history of hypertension or high cholesterol, review of records revealed that he had been treated for hypertension in the past with Loprrssor 50 mg daily ; , and he had also tested positive for elevated cholesterol 272 mg dl ; . In addition, the patient reportedly smoked two packs of cigarettes a day and consumed at least two alcoholic beverages a day. The patient denied any history of coronary artery disease. The patient's blood pressure was 170 90. Examination of the heart revealed a regular rhythm without extra sounds or murmurs. The physician noted that the patient appeared diaphoretic; however, he did not appear to be in acute distress and remained pain-free throughout the examination. CBC, Chem- 7 panel, CPK, CK ISO, Troponin I and chest X-ray were all interpreted as normal. The patient's ECG revealed a left bundle branch block. There were no prior ECGs available for comparison. The ER physician suspected peptic esophagitis as the cause of the burning sensation and advised the patient to take an antacid. The patient was advised by the ER physician to follow up with his primary care physician the following day, and was discharged with instructions to return to the ER or to call his primary care physician should the chest pain recur.
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