Management of hypertensive emergencies

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Most hypertensive crises represent failure of medical management and are preventable by appropriate early identification and therapy. Controlled therapeutic trials in patients with severe hypertension have clearly demonstrated that control of blood pressure can prevent accelerated hypertension and aortic dissection. The number of other complications such as congestive heart failure, progressive azotemia, stroke, and hypertensive neuroretinopathy is also considerably reduced by aggressive antihypertensive therapy.

Although hypertensive emergencies are not common, they still represent a major management problem for emergency room and primary care physicians. Severe and sudden elevation in blood pressure, regardless of cause, is a direct threat to life. In such situations, rapid reduction of blood pressure by parenteral administration of antihypertensive drugs is urgently indicated if the integrity of the cardiovascular system is to be maintained. Prompt reduction of blood pressure will reduce both the morbidity and mortality from hypertensive crises.

Hypertensive crises
  1. Hypertensive encephalopathy (from any cause)

    1. Essential hypertension

    2. Acute or chronic glomerulonephritis

    3. Pre-eclampsia and eclampsia

    4. Renal vascular hypertension

  2. Head injuries

  3. Severe burns

  4. Pheochromocytoma

  5. Sudden release of increased tissue stores of catecholamines when certain drugs or foods are ingested by patients receiving monoamine oxidase inhibitors

  6. Clonidine withdrawal

  7. Some cases of acute coronary insufficiency

  8. Some cases of malignant hypertension

Severe or moderate hypertension complicated by
  1. Acute left ventricular failure

  2. Intracranial hemorrhage

  3. Acute dissecting aneurysm of the aorta

  4. Leaking abdominal aortic aneurysm

  5. Postoperative bleeding at vascular suture lines

  6. Severe epistaxis

Miscellaneous. . .



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