Emergency care for hypertensive crises: how to save a patient? Review of modern recommendations
Background. Arterial hypertension (AH) is a risk factor for stroke and myocardial infarction. In low-income countries, the prevalence of hypertension is 42 %. Hypertensive crisis (HC) is an acute increase in blood pressure – BP (systolic BP >200 mm Hg, diastolic BP >120 mm Hg), which is accompanied by the threat or progression of target organs damage and requires the immediate controlled reduction of BP.
Objective. To describe the emergency care for HC.
Materials and methods. Analysis of current recommendations and literature data.
Results and discussion. HC are classified into uncomplicated (uHC) and complicated (cHC). Perioperative hypertension can be considered a separate subtype of HC. Risk factors for HC include uncontrolled hypertension, refusal to take antihypertensive drugs, emotional stress, excessive fluid and salt intake, alcohol abuse, smoking, physical overload, meteopathic factors, obesity. uHC require BP lowering within 2-6 hours; drugs are administered orally; there is no need for hospitalization. cHC requires BP lowering within 30-120 minutes; drugs are administered intravenously; the patient must be hospitalized. After maintaining the target pressure <160/100 mm Hg within 2-3 hours the patient can be transitioned to the oral drug administration. Therapeutic armamentarium for HC includes nitroprusside, nicardipine, clevidipine, esmolol, labetalol, nitroglycerin, urapidil, and phenoldopam. Labetalol, nicardipine, clevedipine and phenoldopam are not available in Ukraine. The choice of drug should be based on the dominant linjury of the target organ. In case of uHC it is expedient to use nifedipine, captopril, metoprolol, propranolol, clonidine (all of them orally). It should be noted that the parenteral administration of antihypertensive drugs can be carried out only by specially trained personnel with monitoring of BP and hemodynamic parameters, as well as in the presence of conditions for resuscitation. Esmolol (Biblok, “Yuria-Pharm”) is indicated for HC with renal failure, dissection of the aorta or pulmonary edema. It is also advisable to use Biblok in perioperative hypertension. The peculiarities of the Biblok use include the need of infusion into a large diameter vein, usage of lineamats or infusomats, use for no more than 24 hours, and no abrupt termination of the infusion.
Conclusions. 1. HC is an acute increase in BP, which is accompanied by the development or progression of damage of target organs and requires immediate controlled reduction of BP. 2. Risk factors for HC include uncontrolled hypertension, refusal to take antihypertensive drugs, emotional stress, excessive fluid and salt intake, alcohol abuse, smoking, exercise, meteopathic factors, obesity. 3. Esmolol (Biblok) is indicated for HC with renal failure, aortic dissection or pulmonary edema, as well as perioperative hypertension.
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