Hypertension 🚨

✍️Add to Tasks

ℹ️ Intern Note

  • Hypertension is rarely treated acutely on-call unless it is causing symptoms or there is evidence of end-organ damage.
  • Most cases of high blood pressure without symptoms can be safely reviewed on the next ward round.
  • Focus on confirming the reading, ruling out emergencies, and restarting usual meds if safe.

📞 What to Ask on the Phone

  • What is the BP reading and how was it taken?
  • Symptoms: headache, chest pain, visual changes, confusion?
  • Is this new or pre-existing hypertension?
  • Any current antihypertensives prescribed or withheld?

🔍 Initial Assessment

  • Confirm BP manually and in both arms if possible
  • Assess for symptoms: headache, visual changes, confusion, chest pain, SOB
  • Full set of observations (RR, HR, SpO₂, Temp)
  • Check neuro status and fundoscopy if concerned

📚 Definitions

  • Hypertensive Emergency = BP >180/110 with end-organ damage
  • Hypertensive Urgency = BP >180/110 without end-organ damage
  • Asymptomatic high BP is often not an emergency

🧪 Investigations

  • ECG (LVH, ischaemia)
  • U&E (renal function, electrolyte disturbance)
  • Urinalysis (protein/haematuria)
  • CXR if chest pain or SOB
  • Consider CT Brain if neurological signs

💊 Management

  • If hypertensive emergency: consult senior and consider IV antihypertensives (e.g. labetalol)
  • If urgency and asymptomatic: do not rapidly lower BP; consider oral antihypertensives or review next day
  • Restart usual antihypertensives if safe
  • Escalate if symptomatic or concern for end-organ damage

✅ Actions for Interns

  • Document readings and context (manual? machine?)
  • Note any symptoms and differential (e.g. anxiety vs. true emergency)
  • Discuss with medical reg if persistently >200 systolic or if any symptoms
  • Do not chase numbers in asymptomatic patients without clear cause.

Note Template

Ready-to-use clinical note structure

🕒 22 / 11 / 2025 — 03:12

ATRP re: elevated BP
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [HTN / renal / vascular disease]

🧾 Hx:
• Symptoms: [headache, vision changes, chest pain, neuro symptoms]
• Meds: [compliance / recent changes]
• Home readings?

🩺 Exam:
• BP: __ / __  HR: __  RR: __  Temp: __
• Neuro: [alert / focal signs / GCS]
• Fundoscopy: [papilloedema?]
• Chest: [normal / signs of failure]
• Urine: [dipstick for protein/blood]

📋 Impression:
Likely cause: [primary HTN / pain / anxiety / secondary cause]

📌 Plan:
• Repeat BP manually both arms
• Investigate end-organ signs
• Withhold or modify meds
• Escalate if hypertensive emergency

👤 [Your Name], [Role]
✍️Add to Tasks