ABSTRACT
Hypertensive urgencies and emergencies are common situations in clinical practice. Hypertensive urgencies are characterized by acute elevation of blood pressure without target organ damage. Hypertensive emergencies are life-threatening situations characterized by acute elevation of blood pressure and target organ damage. The aims of blood pressure control, antihypertensive drugs to use and route of administration will depend on the presence or absence of target organ damage and individual patient characteristics. The correct diagnosis and treatment of these situations are essential for patient prognosis. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.
Subject(s)
Antihypertensive Agents/therapeutic use , Emergencies , Hypertension, Malignant/drug therapy , Acute Disease , Ambulatory Care , Aortic Dissection/complications , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Catecholamines/metabolism , Hospitalization , Humans , Hypertension, Malignant/diagnosis , Hypertension, Malignant/epidemiology , Hypertension, Malignant/etiology , Hypertensive Encephalopathy/etiology , Hypertensive Encephalopathy/prevention & control , Stress, Psychological/complicationsABSTRACT
Contemporary data on mechanisms of development, types, and clinical picture of hypertensive crisis (HC) are presented. Algorithms of rational therapy of uncomplicated and complicated HC are considered. Appropriateness of the use in HC of antihypertensive drugs with multifactorial action is stressed. These drugs include urapidil - an antihypertensive agent with complex mechanism of action. Blocking mainly the postsynaptic 1-adrenoreceptors urapidil attenuates vasoconstrictor effect of catecholamines and decreases total peripheral resistance. Stimulation of 5HT1-receptors of medullary vasculomotor center promotes lowering of elevated vascular tone and prevents development of reflex tachycardia.
Subject(s)
Antihypertensive Agents , Aortic Aneurysm , Aortic Dissection , Heart Failure , Hypertension, Malignant , Hypertensive Encephalopathy , Algorithms , Aortic Dissection/etiology , Aortic Dissection/prevention & control , Antihypertensive Agents/classification , Antihypertensive Agents/pharmacology , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Disease Management , Emergencies , Emergency Treatment/methods , Heart Failure/etiology , Heart Failure/prevention & control , Humans , Hypertension, Malignant/complications , Hypertension, Malignant/diagnosis , Hypertension, Malignant/etiology , Hypertension, Malignant/physiopathology , Hypertension, Malignant/therapy , Hypertensive Encephalopathy/etiology , Hypertensive Encephalopathy/prevention & control , Piperazines/pharmacology , Piperazines/therapeutic useSubject(s)
Antihypertensive Agents , Blood Pressure/drug effects , Emergency Treatment , Hypertension, Malignant , Pre-Eclampsia/therapy , Acute Disease , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Blood Pressure Determination/methods , Blood Pressure Determination/standards , Emergency Treatment/classification , Emergency Treatment/methods , Emergency Treatment/standards , Female , Humans , Hypertension, Malignant/complications , Hypertension, Malignant/epidemiology , Hypertension, Malignant/physiopathology , Hypertension, Malignant/therapy , Hypertensive Encephalopathy/etiology , Hypertensive Encephalopathy/physiopathology , Hypertensive Encephalopathy/prevention & control , Intracranial Hemorrhage, Hypertensive/etiology , Intracranial Hemorrhage, Hypertensive/physiopathology , Intracranial Hemorrhage, Hypertensive/prevention & control , Male , Patient Education as Topic , Pre-Eclampsia/etiology , Pre-Eclampsia/physiopathology , Pregnancy , Preventive Medicine/methods , Russia/epidemiology , Secondary Prevention/education , Secondary Prevention/organization & administration , Treatment OutcomeABSTRACT
Hypertension is an exceedingly common disorder in Western societies; but, thanks to improved management of chronic hypertension, the number of patients who present with hypertensive crisis (HC) is less than 1%. However, critical elevation of blood pressure (BP) obliges to a proper and immediate management in order to prevent serious injury to organ target of hypertension (brain, heart, kidney and vessels). Moreover, the so called hypertensive emergencies (HE) and the hypertensive urgencies (HU) expect a several therapeutic approach. The HE warrant both prompt admission to an intensive care unit, where it is available a continuous monitoring of BP, and a prompt starting of a therapy with parenteral anti-hypertensive drugs. The treatment of HU can be managed choosing oral anti-hypertensive agents followed by a tight observation of the patient also in ambulatory system, lowering the BP more gradually over 12 to 24-48 hours. The present clinical review is aimed at reporting the current opinions on the management of HC, examining as well the drugs of largest use. Any drug that lowers BP precipitously should be avoided. Choice of the appropriate agent should be based on the underlying pathophysiological and clinical findings, on the mechanism of action, and on its potential side effects.
