Treatment of hypertensive crisis

Article Abstract:

Few people (less than one percent) with hypertension, or high blood pressure, will suffer a hypertensive crisis, in which the diastolic blood pressure (measured during the heart's resting phase) soars above 120 or 130 mm Hg. When patients have diseases leading to organ damage known to result in pressure elevations, a sudden increase constitutes a hypertensive emergency; in the absence of ongoing disease, it is classified as an urgent hypertensive crisis. The causes of hypertensive crisis, which occurs most often among people who have histories of hypertension, are described and listed in tabular form. A common cause is failure to take blood pressure medication, or inappropriately prescribed medication. The initial examination should try to establish whether the patient is undergoing a crisis or an emergency. Correct treatment depends on identifying the cause and determining the patient's blood pressure history. Treatment goals in the case of hypertensive emergency are to reduce the blood pressure gradually; the arterial pressure should decline by 25 percent over the first few minutes or hours. This is often accomplished with intravenous sodium nitroprusside, which requires constant monitoring. Other drugs are evaluated. The causes of hypertensive emergency discussed include: hypertensive encephalopathy (deterioration of brain function); cerebral infarction (blockage of an artery in the brain); hemorrhage in the brain; heart attack; heart failure; aortic dissection (tearing apart of the tissue layers of the aorta, the major artery carrying blood from the heart to the body); eclampsia (a condition of pregnancy); renal insufficiency; drug abuse; tumor of the adrenal gland (pheochromocytoma); certain drug combinations and too-rapid withdrawal of certain therapeutic agents; and lesions of the spinal cord. After the blood pressure of patients in urgent hypertensive crisis has been stabilized, the patients can be sent home after an appropriate period of observation. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Hypertensive crisis since FDR - a partial victory

Article Abstract:

The development of effective antihypertensive drugs has significantly prolonged the survival of patients with malignant hypertension. Malignant hypertension is high blood pressure accompanied by damage to organs such as the eye, brain and kidney. Its cause is not known, but it is thought to be associated with vasoconstriction in the setting of prolonged high blood pressure. President Franklin D. Roosevelt died of a cerebral hemorrhage that was most likely caused by malignant hypertension. Many patients in hypertensive crisis have kidney disease, which could contribute to their symptoms. Survival rates in patients with malignant hypertension have increased dramatically from the use of antihypertensive drugs and kidney dialysis. Patients who do not take their medicine regularly are most likely to have a hypertensive crisis.

Health aspects, Editorial, Roosevelt, Franklin D., Malignant hypertension

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Pathogenesis of hypertension

Article Abstract:

The physiological causes of high blood pressure are reviewed. Topics include genetics, inherited cardiovascular risk factors, sympathetic nervous system, vascular reactivity, vascular remodeling, renal microvascular disease, uric acid, arterial stiffness, the renin-angiotensin-aldosterone system, angiotensin II and oxidative stress, clinical trials of ACE inhibitors and ARBs, aldosterone, endothelial dysfunction, and endothelin.

Physiological aspects, Cookery for hypertensives

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