Management of Hypertensive Emergencies PDF

▌Management of hypertensive emergencies: Hypertensive emergencies are clinical Hypertensive situations associated with one or more of the encephalopathy following: Is a clinical presentation  BP > 180/120mmHg....

▌Management of hypertensive emergencies: Hypertensive emergencies are clinical Hypertensive situations associated with one or more of the encephalopathy following: Is a clinical presentation  BP > 180/120mmHg. consists of severe headache,  Target organ damage e.g. cerebral mental confusion, blurred stroke, encephalopathy, heart failure, vision, and focal neurologic aortic dissection, edema of the optic disc signs. If untreated it may (papilledema). progress over a period of 12– 48 hours to convulsions, Management: coma, and even death. – Hospitalization and start parenteral therapy to lower BP rapidly (within a few hours not minutes). – Chronic hypertension is associated with autoregulatory changes in cerebral, myocardial, and renal blood flow; so if sudden lowering of BP is done, cerebral, renal, and myocardial ischemic events can develop. – The initial target in the first 1-2 hrs is to lower systolic BP by no more than 25%, maintaining diastolic BP at no less than 100 mmHg. – Drugs commonly used: sodium nitroprusside, labetalol, fenoldopam, all are given by slow i.v. infusion. – Recent guidelines state that the following drugs are not recommended:  Nifedipine, nitroglycerin, and hydralazine: because these agents can cause sudden, uncontrolled, and severe reductions in BP that may precipitate cerebral, renal, and myocardial ischemic events with fatal outcomes.  Furosemide can lead to significant volume depletion and should be used only if there is associated volume overload as in case of pulmonary edema and acute heart failure. 163  Part 2 2: The erapy off periph heral vas scular disease d ((PVD) It is a narrowing of the arteries o other thann coronary y and cerrebral ves ssels. It commo only affectss arteries of o lower lim mbs, but also renal and mesentteric arteries. Risk fa actors  Diabbetes and smoking area the mo ost importa ant risk factors.  Age e > 65 yearrs, hyperch holesterole emia, hype ertension and obesityy. Manife estations  Inte ermittent cllaudication n: pain in mmuscles wh hen walkin ng  Resst pain in th he soles off the feet, p particularly y when the e feet are eelevated.  Skinn: cool, blu uish, ischemic ulcerss. gement Manag ▌Life-s style:  Stop smoking: the most important factor  Conntrol of risk k factors:  S Statins for hypercho olesterolem mia.  T Treatment of hyperte ension andd DM. ▌Drug therapy: Pentox xifylline  It in ncreases RBC R deform mability byy inhibition n of PDE enzyme; e thhis effect reduces r bloo od viscositty and facilitates passsage of RBCs through narrow wed capillarries and isch hemic sitess.  It iss the 1st drrug approv ved to imp prove micrrovascular circulationn in patien nts with inte ermittent claudicati c ion, diabettic angioppathy, and chronic leeg ulcers. Typical dosse is 400 mgm twice a day. azol Cilosta  It is the 2nd drug recently y approvedd for treatm ment of inttermittentt claudicattion.  It in nhibits PDEE enzyme (type 3) le V and ↓ platelet agg eading to VD gregation.  Hea adache is the most common c sside effect.  Clioostazol is contraind dicated in patients with CHF F because recent ev vidence sho owed that inhibitors of o PDE enzzyme type 3 increase e mortality in those patients. p Clopid dogrel Antipla atelet agennts such clopidogr el (75 mg g/d) have additionaal benefits s when compa ared with aspirin in diabetic pattients with PVD. 164