MODERN EMERGENCY CARE STRATEGY FOR HYPERTONIC CRISIS

The article is devoted to discussing modern approaches todiagnosis andtreatment in complicated anduncomplicated hypertensive crises.The options for antihypertensive drugs are considereddepending on thenature of target organ damage ina hypertensive crisis.The data on themost frequently prescribed drugs for complicated anduncomplicated hypertensive crisis increases the volumetric velocity of coronary andcerebral blood flowand reduces the pressure inthe pulmonary artery system.It is usually used to relieve the mild uncomplicated hypertensive crisis. Still, a wide range of side effects, including reflex tachycardia, periorbital andperipheral edema, skin redness, pruritus,limits its use.Keywords: cerebral blood flow, routine clinical, hypertension, medical associations, hypertensive crisis

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Hypertensive Crisis in the Elderly Patients

Kardiologiia ◽

10.18087/cardio.2020.5.n1121 ◽

2020 ◽

Vol 60 (5) ◽

pp. 128-135

Author(s):

O. N. Tkacheva ◽

Yu. V. Kotovskaya ◽

K. A. Eruslanova

Keyword(s):

Elderly Patients ◽

Clinical Symptoms ◽

Target Organ Damage ◽

Hypertensive Crisis ◽

The Elderly ◽

Organ Damage ◽

Target Organ ◽

Sudden Increase ◽

Chronic Therapy ◽

High Level

A hypertensive crisis is a sudden increase in blood pressure (BP) to an individually high level associated with clinical symptoms and target organ damage, in which BP must be reduced immediately. Since 2018 in Europe and since 2020 in Russia, an uncomplicated hypertensive crisis is recommended to be considered as a part of malignant (uncontrolled) arterial hypertension. The clinical picture of increased BP in elderly patients is characterized by nonspecific symptoms even in target organ damage. Management of this group of patients requires a physician to know the patient’s comorbidities and the drugs taken on a regular basis to minimize development of side effects of the administered drugs and their undesirable interaction with the chronic therapy.

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A descriptive study on the hypertensive crisis in Visakhapatnam, Andhra Pradesh, India

International Journal of Medical Research and Review ◽

10.17511/ijmrr.2020.i06.02 ◽

2020 ◽

Vol 8 (6) ◽

pp. 386-391

Author(s):

Dr. Salla Surya Prakasa Rao ◽

◽

Dr. Salla Sweta Ramani ◽

Dr. Pudi Venkat Sai Kiran ◽

Dr. Siddanati Kiran Prasad ◽

...

Keyword(s):

Blood Pressure ◽

Andhra Pradesh ◽

Adverse Outcome ◽

Target Organ Damage ◽

Hypertensive Crisis ◽

Descriptive Study ◽

Organ Damage ◽

Target Organ ◽

Elevated Blood ◽

Presenting Symptoms

Objective: The objective of the present study, A Descriptive study on Hypertensive Crisis inVisakhapatnam, India was to evaluate the modes of presentations, clinical profile, and spectrum oftarget organ damage in patients with hypertensive emergencies. Material and Methods: The studypopulation included patients admitted in this hospital with severely elevated blood pressure withclinical or laboratory evidence of acute target organ damage. Result: The clinical and laboratoryprofile of 50 of these patients were evaluated. Males had higher chances of developing ahypertensive emergency compared to females. The commonest presenting symptoms were chestpain, dyspnoea, and neurological deficit. The majority of the patients have known hypertensives.Higher levels of blood pressure at presentation were associated with an adverse outcome. Acute LVFwas the commonest target organ damage observed. In-hospital mortality of 14% was observed inthe present study. Conclusion: Known hypertensives are at a higher risk of presenting with acutetarget organ damage associated with chest pain. Acute LVF is the commonest form of target organdamage encountered in the present study.

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Proportion of isolated clinical hypertension in primary care settings. Comparison of target organ damage in patients with isolated clinical hypertension and patients with sustained arterial hypertension

Blood Pressure ◽

10.1080/08037050701538089 ◽

2007 ◽

Vol 16 (6) ◽

pp. 354-361

Author(s):

Quintí Foguet Boreu ◽

Gabriel Coll de Tuero ◽

Antonio Rodríguez‐Poncelas ◽

Maria Sanmartín Albertos ◽

Marc Saez Zafra ◽

...

Keyword(s):

Primary Care ◽

Arterial Hypertension ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ ◽

Primary Care Settings ◽

Clinical Hypertension

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Abstract 117: Preclinical Target Organ Damage Changes in Patients with Resistant Hypertension Randomized to Renal Denervation or Spironolactone as Add-on Therapy. Results From the DENERVHTA Study

Hypertension ◽

10.1161/hyp.68.suppl_1.117 ◽

2016 ◽

Vol 68 (suppl_1) ◽

Author(s):

Anna Oliveras ◽

Pedro Armario ◽

Laia Sans ◽

Albert Clarà ◽

Susana Vázquez ◽

...

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Linear Models ◽

Antihypertensive Drugs ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Group Differences

Objective: To compare the effect of renal denervation (RDN) and spironolactone, two proposed therapeutic strategies for the treatment of patients with resistant hypertension (RH), on preclinical target organ damage (pTOD). Methods: Patients with office systolic blood pressure (SBP) ≥150 mmHg and 24h-SBP ≥140 mmHg despite receiving ≥3 full-dose antihypertensive drugs, one a diuretic, but none aldosterone antagonist, were randomized to receive RDN or spironolactone (50mg), as add-on therapy. Changes (Δ) in 24h-BP, as well as Δ in urinary albumin excretion (ΔUAE), carotid-femoral pulse-wave velocity (ΔcfPWV), carotid intima-media thickness (ΔIMT), left ventricular mass index (ΔLVMI) and E/e’ (ΔE/e’), a marker of hypertension-induced diastolic dysfunction, were evaluated at 6 months. Between-group comparisons of ΔUAE (after log transformation), ΔcfPWV, ΔIMT, ΔLVMI and ΔE/e’ were carried out by generalized linear models before and after adjusting by Δ24h-SBP and the corresponding baseline value. Results: Twenty-four patients (mean age 64±8 yr) were included. Mean baseline-adjusted difference (95% CI) between the two groups (Spironolactone vs.RDN) at 6 months in 24h-SBP (mmHg) was of-17.9 (-30.9 to -4.9), p=0.01. As shown in the table, there were no statistically significant between-group differences in Δ on pTOD. Conclusion: Changes at 6 months on pTOD as assessed by UAE, cfPWV, IMT, LVMI and E/e’, were not associated with the therapeutic add-on strategy used to reduce high blood pressure in RH patients. We cannot discard that the high variability of some of these markers, especially UAE, could account for this lack of statistically significant between-group differences.

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Approaches to the treatment of uncontrolled hypertension. Place of the Physiotens®

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4535 ◽

2021 ◽

Vol 26 (6) ◽

pp. 4535

Author(s):

S. N. Tereshchenko ◽

V. V. Ruksin ◽

N. I. Gaponova ◽

O. N. Tkacheva ◽

D. V. Duplyakov ◽

...

Keyword(s):

Antihypertensive Therapy ◽

Target Organ Damage ◽

Hypertensive Crisis ◽

Organ Damage ◽

International Classification Of Diseases ◽

Target Organ ◽

Uncontrolled Hypertension ◽

Russian Society ◽

Classification Of Diseases ◽

Icd 10

The paper discusses the issues of managing uncontrolled hypertension. It is noted that in the International Classification of Diseases, 10th revision (ICD-10), there is no diagnosis “hypertensive crisis”, which complicates the epidemiological estimates. In the new Russian Society of Cardiology guidelines, instead of using the term “uncomplicated hypertensive crisis”, the term “sudden pronounced individually relevant blood pressure (BP) increase” was proposed to describe pronounced BP increase without target organ damage. Since the term “uncomplicated hypertensive crisis” is not recommended for use, but this condition is often diagnosed in practice, it is advisable to replace this term with “sharp BP increase not accompanied by target organ damage” or “sudden pronounced individually relevant BP increase”. At the same time, there is no evidence that in patients with uncomplicated hypertensive crisis, a more rapid BP decrease is more effective over the standard antihypertensive therapy in relation to the risk of complications. The drug Physiotens® lowers BP smoothly and without sudden falls, while having favorable pharmacokinetics. The issues of revising the current approaches to antihypertensive therapy in patients with frequent BP increases, as well as the use of original drugs and generics are considered.

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