Differentiated approach to the treatment of uncomplicated hypertensive crisis

Abstract

Abstract Background In primary health care, especially in rural areas, non-standard treatment of hypertensive crises is still used. In the present research study, we wanted to implement proven standards for uncomplicated hypertensive crisis management based on baseline blood pressure. Purpose To explore the clinical and hemodynamic efficiency of urapidil and captopril for the purpose of a differentiated approach to the treatment of uncomplicated hypertensive crisis. Methods The research includes 132 patients with a diagnosis of “Uncomplicated hypertensive crisis” in an average age All patients underwent physical examination, ECG, ECHOKG, ultrasound examination of the brachiocephalic arteries, biochemical analyzes, determination of microalbuminuria to exclude acute damages of organs and systems on account of HCR. All investigations were carried out within 10–15 minutes after the initial address of patients, according to the recommendations of the European Society of Hypertension/European Society of Cardiology (ESH/ESC 2018). Office blood pressure (BP) was measured on admission, 15, 30, 60 and 120 minutes after taking the antihypertensive drug Results The antihypertensive efficacy of urapidil and captopril in uncomplicated hypertensive crisis was assessed by the dynamics of average BP, a decrease in ABP by 10% at the first 30 minutes and by 20–25% within 120 minutes was considered as a positive antihypertensive effect. In the urapidil's group (n=104), BP before treatment corresponded to the 3rd grade of arterial hypertension (AH): 202.33±22.06/105.3±7.82 mm Hg. Urapidil at an average dose of 44.6 mg significantly reduced the BP by −27.27±4.7% by 120 minutes. In the captopril's group (n=28), BP also corresponded to the 3rd grade of AH (192.5±23.76/103.53±6.85 mm Hg), whereas systolic BP was significantly lower than systolic BP in the urapidil's group. Despite this, captopril at an average dose of 33.2 mg did not show a sufficient decrease of average BP by the 120 minutes, and an intergroup significant difference in the degree of decrease in BP was revealed: −16.94±5.25% in the captopril group versus −27.27±4.7% in the urapidil group, p<0.005. But captopril showed sufficient antihypertensive efficacy in 7 patients with 2nd grade of AH (172.71±8.08/101.85±1.8 mm Hg), reducing the BP by −21.19±3.03%. Conclusion A differentiated approach to the reduction of uncomplicated hypertensive crisis with urapidil and captopril showed a high clinical and hemodynamic efficacy of urapidil in patients with the 3rd grade of arterial hypertension. The effectiveness of captopril was limited in patients with the 3rd grade of hypertension, while in patients with the 2nd grade of hypertension, captopril showed a significantly clinical and hemodynamic effects. Funding Acknowledgement Type of funding sources: None.