The management of hypertensive crises: a clinical review.
ABSTRACT 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.
Full-textDOI: · Available from: Mario Pergolini, Apr 02, 2014
- SourceAvailable from: Thomas Marbury[Show abstract] [Hide abstract]
ABSTRACT: Clevidipine is a rapidly-acting intravenous dihydropyridine antihypertensive acting via calcium channel blockade. This was a randomized, single-blind, parallel-design study of a 72-h continuous clevidipine infusion. Doses of 2, 4, 8, or 16.0 mg/h or placebo were evaluated in 61 subjects with mild to moderate essential hypertension. IV clevidipine or placebo was initiated at 2.0 mg/h and force-titrated in doubling increments every 3 min to target dose, then maintained for 72 h. Blood pressure and heart rate were measured during infusion, and for 4, 6 and 8 h after termination of infusion, although oral therapy could be restarted at 4 h. Clevidipine blood levels were obtained during infusion and for 1 hour after termination. Rapid onset of drug effect occurred at all clevidipine dose levels, with consistent pharmacokinetics and rapid offset after 72-h infusion. No evidence of tolerance to the clevidipine drug effect was observed at any dose level over the 72-h infusion. No evidence of rebound hypertension was found for either 4 or 6 h after termination of the clevidipine infusion. At 8 h following cessation of clevidipine, blood pressure was not significantly higher than at baseline. Placebo-treated subjects had blood pressures lower than baseline at 8 h following infusion termination; hence, placebo-adjusted blood pressures tended to be slightly higher than baseline. This study supports the use of up to 72 h of IV clevidipine therapy for the management of blood pressure, with consistent pharmacokinetic/pharmacodynamic characteristics and context insensitive half-life across the dose ranges evaluated.European Journal of Clinical Pharmacology 03/2012; 68(10):1385-94. DOI:10.1007/s00228-012-1260-3 · 2.70 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: L’extrait aqueux de Ziziphus mauritiana (Zm) dans un intervalle de doses compris entre 0,4 et 122 mg/kg de PC provoque chez le lapin une hypotension dose-dépendante comparable à celle de l’acétylcholine (Ach). En présence de doses croissantes d’atropine comprises entre 4,10−3 et 4,84 μg/kg de PC, l’hypotension induite par l’acétylcholine (Ach) à 4,10−3 et par Zm à 22 mg/kg de PC chez le lapin est progressivement inhibée. Cette inhibition est totale pour l’acétylcholine quand l’atropine est dosée à 4,84 μg/kg de PC, tandis qu’elle est partielle pour Ziziphus mauritiana même à cette concentration. Ces résultats suggèrent que certains principes actifs contenus dans l’extrait brut de Ziziphus mauritiana seraient des substances cholinomimétiques de type muscarinique. En conclusion, ces travaux justifient, au moins en partie, l’utilisation par les tradithérapeutes africains de Ziziphus mauritiana dans le traitement de l’hypertension artérielle. The extract Zizyphus mauritiana (Zm) in the dose range 0.4 to 122 mg/kg Pc, causes dose-dependent hypotension in rabbits, similar to that achieved with acetylcholine (ACh). In the presence of increasing doses of atropine, ranging from 4.10−3 to 4.84 μg/kg PC, hypotension induced in rabbits by acetylcholine (ACh) at 4.10−3 and ZM at 22 mg/kg at PC is progressively inhibited. This inhibition is total for acetylcholine when atropine is dosed at 4.84 μg/kg PC, while it is partial for Zizyphus mauritiana even at this concentration. These results suggest that some of the active ingredients contained in the crude extract of Zizyphus mauritiana might be cholinomimetic substances of the muscarinic type. In conclusion, this work justifies, at least partially, the use by African tradipractitioners of Zizyphus mauritiana in the treatment of hypertension.Phytotherapie 08/2008; 6(4):219-227. DOI:10.1007/s10298-008-0322-2
- [Show abstract] [Hide abstract]
ABSTRACT: Glomerular diseases are common in elderly patients and are a major cause of kidney failure. Most glomerular diseases in the elderly are caused by chronic systemic diseases, including arterial hypertension, diabetes, and atherosclerotic vascular diseases, although acute systemic vasculitis, especially anti-neutrophil-cytoplamic-antibody-mediated vasculitis, and membranous nephropathy related to malignancy, drug toxicity, and idiopathic form also occur often. Complex age-related changes and sensitivity to drug toxicity can render diagnosis and treatment for elderly patients challenging. As the general population is aging and the rate of CKD rising, updating knowledge on managing these patients is critical for care providers. We provide a comprehensive review and update of the diagnosis and treatment of glomerular diseases in the elderly.Advances in chronic kidney disease 03/2014; 21(2):228-246. DOI:10.1053/j.ackd.2014.01.004 · 1.94 Impact Factor