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Encephalopathy, Hypertensive: Follow-up

Author: Ryan C Chang, MD, Consulting Staff, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, Kaiser Permanente San Francisco
Coauthor(s): Irawan Susanto, MD, Director of Pulmonary Consultation and Procedures, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

Further Inpatient Care

  • Acute inpatient intensive care unit monitoring with arterial blood pressure monitoring is required for adequate titration of pharmacologic agents. Routinely perform neurologic reassessment to monitor signs of deterioration due to inadequate treatment, progression of neurologic insult, overzealous reduction in blood pressure, or alternate etiology of the clinical presentation.
  • Quickly and effectively treat severe hypertension to avoid progression to coma and death. If invasive monitoring is not immediately available, initiate alternate therapy with agents that do not require close monitoring until a monitored situation becomes available.

Further Outpatient Care

  • Regularly reassess hypertension because it is a chronic problem. Adequate control of hypertension is essential in preventing the progression of target organ disease.
  • High blood pressure has been associated with a rapid rate of cognitive decline and an increased risk of cardiac and neurologic events.
  • To guide the formulation of an effective treatment plan, document prior hypertensive medication regimes that have failed.

Inpatient & Outpatient Medications

  • Discharge patients on antihypertensives that were effective in maintaining an adequate blood pressure range during hospitalization.

Deterrence/Prevention

  • Recommend lifestyle modifications, including weight reduction to decrease body mass index (BMI) to less than 27, moderation of alcohol and sodium intake, increasing physical activity, and avoidance of tobacco products.
  • Patients should adhere to antihypertensive therapy and schedule reassessment at regular intervals to modify failing regimens.

Complications

  • Complications of hypertensive encephalopathy result in neurologic deficits from hemorrhage and strokes, which can progress to death.
  • Complications of hypertension include the following
    • Coma
    • Death
    • Stroke
    • Nephropathy
    • Myocardial ischemia/infarction
    • Nephropathy
    • Retinopathy
    • Peripheral vascular disease

Prognosis

The morbidity and mortality associated with hypertensive encephalopathy are related to the degree of target organ damage. Without treatment, the 6-month mortality rate for hypertensive emergencies is 50%, and the 1-year mortality rate approaches 90%.

Patient Education

  • Refer patients to a dietitian to reduce the risk of vascular and hypertensive disease.
  • Encourage lifestyle modifications, including smoking cessation, increasing exercise, moderation of alcohol, and avoidance of tobacco.
  • Educate patients about medication adherence and compliance and enforce the need for medical compliance. Educate patients regarding the effects of uncontrolled hypertension, including the complications of persistent hypertension. Inform patients about signs of acute target organ damage, including visual changes, persistent headaches, and neurological changes.

Miscellaneous

Medicolegal Pitfalls

  • Hypertensive encephalopathy is a diagnosis of exclusion, and other potentially life-threatening etiologies must be considered in assessing a patient with neurologic deficits.
  • Deterioration of clinical status despite therapy warrants immediate and further investigation into other possible etiologies or reevaluation of therapy for worsening hypertensive encephalopathy.
  • Monitor complications of medical therapy (eg, overzealous reduction in blood pressure, adverse effects or toxicity of pharmacological therapy).
 


More on Encephalopathy, Hypertensive

Overview: Encephalopathy, Hypertensive
Differential Diagnoses & Workup: Encephalopathy, Hypertensive
Treatment & Medication: Encephalopathy, Hypertensive
Follow-up: Encephalopathy, Hypertensive
References
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References

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Further Reading

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Keywords

hypertension, encephalopathy, hypertensive encephalopathy, hypertensive crisis, hypertensive emergency, hypertensive urgency, accelerated hypertension, malignant hypertension, arteriolar damage, necrosis, atherosclerosis

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Contributor Information and Disclosures

Author

Ryan C Chang, MD, Consulting Staff, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, Kaiser Permanente San Francisco
Ryan C Chang, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Irawan Susanto, MD, Director of Pulmonary Consultation and Procedures, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, University of California at Los Angeles School of Medicine
Irawan Susanto, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Oleh Wasyl Hnatiuk, MD, Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences
Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM, Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair, Academic Affairs, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center
Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, Shock Society, and Society of Critical Care Medicine
Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

 
 
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