Hypertensive crisis
Hypertensive crisis includes two terms: emergency - in which a high and sudden elevation of arterial pressure (AP) leads to acute damage to target organs, and urgency - with no acute damage. Mechanisms leading to the hypertensive crisis are not sufficiently clarified. The renin-angiotensin system plays a key role and may be a primary factor in patients with renovascular hypertension. It may also be secondary elevated due to renal ischemia, depletion of volume or increased sympathicus activity. Angiotensin II directly provokes vasoconstriction, increases the concentration of IL-6 and NF-kB, and reduces the synthesis of nitrogen oxide, leading to the blood vessels endothelial dysfunction. The emergency patients should be administered their medication parenterally, along with lowering of the systolic AP by 25% of the initial value or the diastolic AP of 100-110 mmHg within one hour. The urgency therapy is administered orally, along with a more gradual decrease of AP up to 20% of the initial values. The preoperative treatment of hypertensive crisis is not different from the recommendations for general care of the hypertensive crisis patients. In cardiac surgery, the goal is to maintain the AP within the target values <140/90 mmHg. For the non-cardiac patients, the goal of the post-surgical follow-up is to lower the AP by 20-25% of the pre-operative baseline values. The choice of treatment in these hypertensive crises depends on the associated conditions.
Key words:
arterial hypertension; hypertensive crisis, emergency; hypertensive crisis, urgency; target organ damage
OGLASI
