Management of hypertensive crises

Article Abstract:

In many patients, high blood pressure (hypertension) is an asymptomatic condition which persists for years before its pathological effects become apparent. However, hypertensive crises that demand immediate attention and prompt intervention can and do occur. Traditionally, crises regarded as emergencies are treated with intravenous drugs, usually sodium nitroprusside, and crises regarded as urgent, but not true emergencies, have been treated with oral drugs. However, with the advent of new oral drugs that can reduce severe hypertension in as little as 30 minutes, the distinction between emergencies and urgencies has become more arbitrary, at least as far as treatment is concerned. Various emergencies and urgencies of high blood pressure are discussed in detail. These include many brain disorders. In hypertensive encephalopathy, the blood pressure extraordinarily high, often exceeding 250 millimeters of mercury. There is wide agreement that when hypertension affects brain function directly, intervention should be prompt. However, there is less agreement about whether other brain conditions should be similarly treated. For example, intracranial hemorrhages are often a direct result of hypertension. However, after the hemorrhage occurs, it is not certain that the reduction of blood pressure provides any benefit. Indeed, in the stressful state that follows a hemorrhage, the reduction of blood pressure may actually deprive the brain of oxygen and induce further damage. The treatment of hypertension is beneficial in cases of acute heart failure; sodium nitroprusside may confer benefits for the patient by reducing the workload of the heart even if the patient is not hypertensive. However, during a heart attack, treatment to restore blood flow to the heart muscle is far more important than any treatment for hypertension. Eclampsia is a special condition in which a pregnant woman develops high blood pressure and convulsions. It is an excellent example of how the critical nature of a hypertension crisis depends on the situation, not on the actual extent of the high blood pressure. Pregnant women can develop seizures when the high blood pressure is only 160 over 110, which is very modest pressure for many chronic hypertensive patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antihypertensive drugs, Antihypertensive agents

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Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial

Article Abstract:

Comprehensive lifestyle changes can effectively lower blood pressure without drugs, according to a study of 810 adults. This study compared advice only with the DASH diet and lifestyle changes such as weight loss, dietary sodium reduction, increased physical activity, and limiting alcohol use. The group that began the DASH diet and implemented the other lifestyle changes were most likely to achieve a healthy blood pressure. The DASH diet focuses on fruits, vegetables, whole grains, poultry, fish, and low-fat dairy products.

Cooking, Life style, Lifestyles, Cookery for hypertensives

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Reduction in mortality of persons with high blood pressure, including mild hypertension

Article Abstract:

The editors of JAMA reprint a 1979 article showing that stepped care consisting of regular antihypertensive use with increased dosages was more effective in lowering blood pressure than traditional care. Those in the stepped care group were able to control their blood pressure better than those in the traditional care group. The mortality rate in the stepped care group was also lower than in the traditional care group.

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