The management of hypertensive crises: A clinical review

Department of Medical Clinics and Therapy, I Faculty of Medicine and Surgery, University Sapienza, Rome, Italy.
La Clinica terapeutica (Impact Factor: 0.33). 01/2003; 160(2):151-7.
Source: PubMed


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.

Download full-text


Available from: Mario Pergolini, Apr 02, 2014
  • Source
    • "Dihydropyridine antihypertensive drugs were recommended for MAOinhibitor related moderate hypertension [46]. A low dose of short-acting nifedipine met this aim for the present patient with a blood pressure of 180/105 mmHg however, this approach is no longer advised in hypertensive crisis [47]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Monoamine oxidase-(MAO)-inhibitors are a treatment of last resort in treatment resistant depression, which is regarded as a condition of increased psychiatric risk. General and regional anesthesia for elective surgery during use of long-term MAO-inhibitors remains a matter of debate because of an increased risk of drug interactions and decreased sympathetic stability. A series of case reports and new comparative studies reveal the safety of anesthesia/analgesia in non-cardiac surgery without discontinuation of the MAO-inhibitor if best effort is made for maintenance of sympathetic homeostasis and if known drug interactions are avoided. Very few reports with severe adverse incidents have been noted. Severe cardiovascular morbidity, a contraindication of MAO-inhibitors, probably contributed to peri- and postoperative complications. According to new studies, the risk of pharmacokinetic drug interactions is lower for tranylcypromine than for phenelzine. In the present case, a 66-year-old psychiatric patient on permanent treatment with 20 mg/day tranylcypromine was admitted for forefoot surgery. Anesthetic premedication consisted of 7.5 mg oral midazolam. Intravenous midazolam (0.5 mg) was dispensed for intraoperative sedation. After local anesthesia of the puncture site with 30 mg isobar prilocaine, spinal anesthesia was achieved by a single shot of 13.5 mg hyperbar bupivacaine (0.5%) intrathecally. Postoperative regional and general analgesia were accomplished by a peripheral nerve block with 50 mg isobar bupivacaine as well as oral etoricoxib and oxycodone. No peri- or postoperative complications were encountered. It is concluded that general or regional anesthesia for noncardiac surgery without discontinuation of MAO-inhibitor treatment may be a safe intervention after careful evaluation of an individual's perioperative and psychiatric risk. The increased psychiatric risk in patients treated with MAO-inhibitors outweighs the increased, however manageable, perioperative risk from continuing treatment during surgery.
    International journal of clinical pharmacology and therapeutics 09/2013; 51(10). DOI:10.5414/CP201898 · 1.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Résumé L’étude des effets pharmacologiques d’un extrait hydroalcoolique de Curcuma longa Linné (Zingiberaceae) [Cl] sur la pression artérielle couplée à la respiration du lapin dans un intervalle de concentrations compris entre 5,5 × 10−4 et 4,4 × 10−2 g/kg de PC montre que cette substance d’origine végétale induit des effets hypotenseurs dose-dépendants. Ces effets s’accompagnent d’une augmentation de la fréquence et d’une diminution de l’amplitude respiratoire. Dans un intervalle de concentrations compris entre 10−6 et 10−3 mg/ml, ce même extrait provoque des effets inotrope et chronotrope négatifs dose-dépendants sur le coeur isolé de rat. Par ailleurs, il induit une forte diminution dose-dépendante des contractions rythmiques du duodénum isolé du lapin à des concentrations comprises entre 2 × 10−2 et 1,2 × 10−1 mg/ml. Ces effets négatifs de l’extrait hydroalcoolique de cette espèce végétale rappellent les effets bien connus des antagonistes calciques. Afin de comprendre le mécanisme d’action des substances contenues dans cet extrait, nous avons comparé les interactions entre acétylcholine (ACH)-Cl et ACH-atropine (ATR) et chlorure de baryum (BaCl2)-ATR-Cl pour trois concentrations différentes de BaCl2. La présence de substances anticalciques dans l’extrait hydroalcoolique de cette plante est confirmée par le fait que, contrairement à l’ATR qui est un inhibiteur compétitif des récepteurs cholinergiques muscariniques, Cl inhibe les effets inotropes positifs induits par le BaCl2 qui est un stimulateur de la motilité intestinale comparable au calcium. L’augmentation du rythme respiratoire du lapin induit par l’extrait brut de Curcuma longa pourrait être due à l’existence dans cet extrait de substances autres que les substances anticalciques.
    Phytotherapie 02/2011; 9(1). DOI:10.1007/s10298-010-0600-7

Show more