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[Rational treatment of hypertensive crises]
1Departamento de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080 México, D. F. ujuarez@mail.medinet.net.mx
Insights
Hypertensive crisis requires prompt emergency room evaluation to distinguish between emergencies and urgencies based on end-organ damage. Treatment is individualized, focusing on gradual blood pressure reduction to prevent complications.
Area of Science:
- Cardiovascular Medicine
- Emergency Medicine
- Nephrology
Context:
- Hypertensive crisis is a critical condition requiring immediate medical attention.
- Distinguishing between hypertensive emergencies and urgencies is vital for appropriate patient management.
- Patients may present with previously undiagnosed hypertension.
Purpose:
- To outline the critical differences between hypertensive emergencies and urgencies.
- To emphasize the importance of early recognition and evaluation in the emergency setting.
- To provide guidance on the initial management strategies for hypertensive crisis.
Summary:
- Hypertensive crisis encompasses emergencies with acute end-organ damage (neurological, renal, cardiovascular) and urgencies.
- Recognition is crucial in the emergency room; no arbitrary blood pressure level defines the distinction.
- Treatment is individualized, often involving gradual mean arterial pressure reduction (max 20% in 48 hrs or diastolic not < 100 mmHg), ideally in an ICU.
- Asymptomatic patients with high readings may not require parenteral treatment; underlying causes must be investigated.
Impact:
- Facilitates accurate diagnosis and timely intervention for patients with hypertensive crisis.
- Guides healthcare professionals in emergency settings for effective patient triage and treatment selection.
- Contributes to improved patient outcomes by preventing severe complications associated with uncontrolled hypertension.
Abstract:
The Hypertensive Crisis can be divided into Emergencies and Urgencies. Hypertension may be unknown at presentation. The Emergencies have acute or ongoing end-organ damage (neurological, renal or cardiovascular). It is crucial to recognize one from another already at the emergency room evaluation. There is no arbitrary level of blood pressure separating hypertensive emergencies and urgencies. Ideally, this patients must be treated in an intensive care unit. The level to which the blood pressure should be lowered and the election of the treatment, parenteral versus oral, depends on the patient's general condition and should be individualized. The general recommendation is to reduce the mean arterial pressure gradually in the first 48 hours by no more than 20 percent or to a diastolic blood pressure not lower than 100 mmHg. A relatively asymptomatic patient, even with high diastolic lectures does not need to be treated with parenteral drugs. The patient should be evaluated for possible factors that may have contributed to the high of blood pressure and the progression of hypertension.