From the Guidelines
Hypertensive urgency and hypotension with altered mental status can occur in various conditions, including pheochromocytoma, medication effects, autonomic dysfunction, and central nervous system disorders, and require immediate hospitalization and careful management to stabilize blood pressure and address the underlying cause. The conditions that can cause hypertensive urgency and hypotension with altered mental status include:
- Pheochromocytoma, a catecholamine-secreting tumor that can cause blood pressure spikes and crashes 1
- Medication effects, such as clonidine rebound hypertension followed by overdose-related hypotension 1
- Autonomic dysfunction, which can cause unstable blood pressure regulation 1
- Central nervous system disorders, such as hypertensive encephalopathy, which can cause severe hypertension and altered mental status 1
- Other conditions, such as acute coronary event, acute cardiogenic pulmonary edema, and acute aortic disease, which can cause hypertensive urgency and hypotension with altered mental status 1
Treatment of these conditions depends on the underlying cause, but typically involves careful blood pressure management with medications like labetalol or nicardipine for hypertension, and fluid resuscitation or vasopressors like norepinephrine for hypotension 1. It is essential to identify and address the underlying cause of the condition, as well as to stabilize blood pressure and manage symptoms to prevent further complications and improve patient outcomes 1. The management of altered mental status, including delirium and psychosis, is also crucial in these conditions, and may involve non-pharmacological approaches, medication, and effective aftercare planning 1.
In terms of specific management, the use of labetalol or nicardipine for hypertension, and fluid resuscitation or vasopressors like norepinephrine for hypotension, is recommended 1. Additionally, the use of validated assessment scales, such as the Richmond Agitation Sedation Scale and Glasgow Coma Scale, can help to objectively quantify the severity of symptoms and guide management decisions 1. Overall, the management of hypertensive urgency and hypotension with altered mental status requires a comprehensive and multidisciplinary approach, taking into account the underlying cause, symptoms, and patient outcomes 1.
From the FDA Drug Label
OVERDOSAGE Overdosage with labetalol HCl injection causes excessive hypotension that is posture sensitive, and sometimes, excessive bradycardia. The conditions that can cause hypotension with altered mental status are:
- Overdosage with labetalol HCl injection 2
- Hypertensive urgency is not mentioned in the context of causing hypotension with altered mental status. The information provided does not directly support a conclusion about conditions that cause hypertensive urgency and hypotension with altered mental status.
From the Research
Conditions Causing Hypertensive Urgency and Hypotension with Altered Mental Status
- Hypertensive urgency is characterized by an acute and critical increase in blood pressure without signs or symptoms of acute hypertensive target organ damage 3
- Hypertensive emergency is defined as a severe elevation in blood pressure associated with evidence of new or worsening organ damage, such as stroke, myocardial infarction, or heart failure 4, 3, 5
- Altered mental status can be a symptom of hypertensive emergency, particularly if there is evidence of target organ damage affecting the brain 4, 3
- Hypotension with altered mental status can occur in patients with hypertensive emergency if blood pressure is lowered too quickly or excessively, leading to decreased cerebral perfusion 5
Underlying Causes and Management
- The management of hypertensive urgency and emergency depends on the underlying cause of the crisis, patient demographics, cardiovascular risk, and comorbidities 5
- Oral antihypertensive therapy is usually sufficient for hypertensive urgencies, while intravenous antihypertensive medications are required for hypertensive emergencies 4, 3, 5
- A gradual lowering of blood pressure over 24-48 hours is recommended for hypertensive urgencies, while a more rapid reduction in blood pressure is necessary for hypertensive emergencies 3, 5