
Incorporating: Acute GP, SDEC, UTC
Significant Hypertension
Please click here for a visual summary of the latest NICE guidance, Aug 2019.
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Please note, same day specialist assessment is reserved for those with a BP over (either systolic or diastolic in excess of) 180/120 mmHg AND
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Malignant hypertension criteria (2)
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• retinal haemorrhage or papilloedema (accelerated hypertension) or, often with a severre headache and blood and protein in the urine
• life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury or
• suspected pheochromocytoma (for example, labile or postural hypotension, headache, palpitations, pallor, abdominal pain or diaphoresis)*
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​Without these indications to admit, the Renal team have developed the following advice:
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(1) Add-on therapy:​
Aim to get a balance between the angiotensin system blockade, beta blockers and vasodilators (they workj in synchrony.
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(2) Malignant hypertension criteria - see top of page
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(3) Increase in therapy:
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(4) Booking ultrasound:
For Virtual Ward referrals oly: Request the ultrasound as "Urgent Outpatient" under Responsible Clinician Dr Mark Battle
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*More on clinical presentation of pheochromocytoma
Symptoms and signs of pheochromocytoma include the following:
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Headache
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Sweating
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Palpitations
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Tremor
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Nausea
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Weakness
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Pallor
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Anxiety, sense of doom
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Epigastric pain
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Flank pain
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Constipation
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Weight loss
The classic history of a patient with a pheochromocytoma includes spells characterized by headaches, palpitations, and diaphoresis in association with severe hypertension. These 4 characteristics together are strongly suggestive of a pheochromocytoma. In the absence of these 3 symptoms and hypertension, the diagnosis may be excluded. (Blake 2020 Medscape.com)
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