Treatment Of Hypertensive Crisis Research Articles

Prevention and management of hypertensive crises in children with pheochromocytoma and paraganglioma.

Hypertensive crises in pediatric patients are rare conditions. However, determining their precise prevalence is more challenging than in adults due to the heterogeneity in the definition itself. These crises frequently occur without a prior diagnosis of hypertension and may indicate an underlying cause of secondary hypertension, including pheochromocytoma/paraganglioma (PPGL). The mechanisms of hypertensive crises in the pediatric population with PPGL are directly related to different types of catecholamine excess. Noradrenergic tumors typically present with sustained hypertension due to their predominant action on α1-adrenoceptors in the vasculature. Conversely, adrenergic tumors, through epinephrine binding to β2-adrenoceptors in addition to stimulation of α1- and α2-adrenoceptors, more frequently cause paroxysmal hypertension. Furthermore, the biochemical phenotype also reflects the tumor localization and the presence of a genetic mutation. Recent evidence suggests that more than 80% of PPGL in pediatric cases have a hereditary background. PPGL susceptibility mutations are categorized into three clusters; mutations in cluster 1 are more frequently associated with a noradrenergic phenotype, whereas those in cluster 2 are associated with an adrenergic phenotype. Consequently, the treatment of hypertensive crises in pediatric patients with PPGL, reflecting the underlying pathophysiology, requires first-line therapy with alpha-blockers, potentially in combination with beta-blockers only in the case of tachyarrhythmia after adequate alpha-blockade. The route of administration for treatment depends on the context, such as intraoperative or pre-surgical settings, and whether it presents as a hypertensive emergency (elevated blood pressure with acute target organ damage), where intravenous administration of antihypertensive drugs is mandatory. Conversely, in cases of hypertensive urgency, if children can tolerate oral therapy, intravenous administration may initially be avoided. However, managing these cases is complex and requires careful consideration of the selection and timing of therapy administration, particularly in pediatric patients. Therefore, facing these conditions in tertiary care centers through interdisciplinary collaboration is advisable to optimize therapeutic outcomes.

Hypertensive Emergency: Parenteral Antihypertensives and Population Data.

Review parenteral therapeutic choices in treatment of hypertensive crises by mechanism of action and summarize recent literature on the management of hypertensive crises. Recent data have documented the safety and efficacy of labetalol and nicardipine in treatment of hypertensive crises as well as characterized the hypertensive emergency population to a much greater extent. Based on recent data, hypertensive emergencies are seen in 0.5% of all emergency room visits. Ischemic stroke and heart failure/pulmonary edema are the most common forms of organ damage seen in hypertensive emergencies. There are many therapeutic choices in treatment of hypertensive crises with varied mechanisms of action. Large randomized, controlled trial evidence is lacking in this therapeutic area; however, recent data have documented the safety and efficacy of labetalol and nicardipine.

A comparative study of intravenous labetalol VS intravenous nitroglycerin in the treatment of hypertensive crises

Hypertensive crises is still a major public health problem, causing end organ damage like myocardial infarction, stroke, and renal failure. Labetalol and nitroglycerine are among the two most commonly used medicine to control the blood pressure, but there is no head to head comparison between these two medicines. This was a prospective randomized non-blinded study which included 50 patients of hypertensive crises, out which 25 patients received intravenous labetalol and 25 patients received intravenous nitroglycerine. We found that labetalol controlled the blood pressure more rapidly in comparison to nitroglycerine, without causing any extra side effect.

The Results of Experimental testing of the Program of Physical Therapy of Sambo wrestlers (Masters) after treatment of Hypertensive Crisis

According to the Results of a number of previous Scientific researches, members of the Research Group found that the development and further testing of Physical Therapy Programs for veterans of older age groups after treatment of Hypertensive Crisis – is insufficient further research.
 The main Purpose of the Research is to test the Experimental Program of Physical Therapy for veteran athletes (Masters) who specialize in the Martial Arts against Sambo wrestling after treatment of Hypertensive Crisis. The following Research Methods were used in the Process of Research and Analytical work: abstraction, analysis and synthesis, induction and deduction, modeling, mathematical and statistical (correlation and factor analysis, scaling), etc.
 As a Result of Empirical Research, members of the Research Group adjusted the Pedagogical Conditions that ensure the recovery of veteran Sambo wrestlers after treatment of Hypertensive Crisis. Our modernized experimental "Program of Physical Therapy of veteran Sambo wrestlers after treatment of Hypertensive Crisis" provided: increase of Physical and Special physical readiness; improvement of Technical and Tactical training of athletes (veteran Sambo wrestlers) of the studied category.

Treatment of emergency conditions (hypertensive crisis) in children with arterial hypertension

The article presents a modern classification of hypertensive crises in children. The authors describe detailed tactics of emergency care of hypertensive crises in children. They consider the treatment of hypertensive crises with beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, alpha blockers. The article contains a table of the main antihypertensive medications used to treat hypertensive crises.

Hypertensive crisis in modern guidelines: how to avoid mistakes in diagnosis and treatment. Based on the materials of the XXVI Russian National «Human and Medicine» Congress and the III Cardiology Summit

The prevalence of hypertension is about 40 % according to Russian and world statistics. Approximately 1-2 % of patients with hypertension have high blood pressure throughout their lives, which requires urgent or emergency care. Hypertensive crisis is an acute condition caused by a sudden increase in blood pressure to individually high values, accompanied by clinical symptoms and requiring a controlled reduction to prevent target organ damage. According to the severity of clinical symptoms, hypertensive crisis is divided into uncomplicated and complicated. Typical signs of hypertensive crisis include malignant hypertension, severe hypertension associated with other clinical conditions, a sudden increase in blood pressure due to pheochromocytoma associated with organ damage, severe hypertension during pregnancy or preeclampsia. Hypertensive crisis is associated with various acute conditions, most often stroke (ischemic and hemorrhagic), acute cardiogenic pulmonary edema, acute heart failure, acute coronary syndrome, acute kidney injury, acute aortic dissection and eclampsia. The main goals of the treatment of hypertensive crisis are relief of the crisis, post-crisis stabilization, and prevention of repeated hypertensive crises. In patients with an uncomplicated hypertensive crisis, a decrease in mean blood pressure by 10 % during the first hour and by another 15 % during the next 2-3 hours is recommended. Therapy of complicated hypertensive crisis consists in the mandatory use of intravenous drugs with a predictable and controlled effect. The prognosis in patients with a hypertensive crisis, especially complicated one, is not favorable due to the high risk of short-term and long-term mortality. Patients who have undergone a hypertensive crisis require long-term follow-up.

Management of Hypertension on the Labor and Delivery Unit: Delivering Care in the Era of Protocols and Algorithms.

Preeclampsia with severe hypertension, which occurs in 5% to 8% of pregnancies, is a leading cause of maternal and perinatal morbidity and mortality in the US. Early recognition and treatment of hypertensive crises can significantly reduce poor outcomes. A protocol to ensure prompt treatment with antihypertensive medication (intravenous labetalol) was implemented at our institution. To determine adherence to this protocol on the Labor and Delivery Unit. Retrospective chart review was performed for patients admitted to the Labor and Delivery Unit between April 2015 and June 2015. Charts were reviewed if the patient had a diagnosis of chronic hypertension, gestational hypertension, superimposed preeclampsia, preeclampsia with severe features, eclampsia, or stroke in pregnancy. Only patients with confirmed severe blood pressures, in which the protocol would be initiated, were included in the final analysis. Overall compliance with the entire protocol. Of 178 cases reviewed, 58 (32.6%) had confirmed severe blood pressures. Most patients (n = 46, 79.3%) received a diagnosis of preeclampsia with severe features, and most delivered via cesarean delivery (n = 38, 65.5%). No cases were compliant with the entire labetalol protocol. Of 58 patients, 2 (3.5) adequately repeated a confirmation blood pressure within 5 minutes, and 34 (58.6%) were adequately treated with intravenous labetalol according to protocol requirements. Labetalol treatment was appropriately initiated in many cases; however, protocol adherence could greatly improve. Potential factors affecting protocol compliance include shift changes, communication issues, and conflicting protocols. Institutions should review protocol compliance to improve care.

An experimental model for hypertensive crises emergencies: Long-term high-fat diet followed by acute vasoconstriction stress on spontaneously hypertensive rats.

Currently, the prevention and treatment of hypertensive crises especially when it occurs with serious adverse outcomes have led to worldwide controversy. Despite of clinical possibilities of multiple agents, clinical failures still occur frequently. Therefore, early evaluations and observations of different therapies on appropriate animals should be emphasized. In the present study, an animal model for hypertensive crises emergencies was firstly established and experimentally testified. Five-month-male spontaneously hypertensive rat was consecutively fed with 60%-Kcal fat diet for four, six, and eight weeks with body weight and blood pressure monitored every two weeks, and then followed by an acute vasoconstriction stress of 5-min ice-bath treatment in the 4-h time interval of two adrenaline injections (0.8 mg/kg). Forty-four biochemical parameters were detected, covering hepatic and renal function, blood glucose and lipid levels, myocardial enzymes and energy metabolisms, blood coagulative and anti-coagulative system, oxidative stress and anti-inflammatory cytokine, blood viscosity, and RAAS system. Six tissues including heart, brain, liver, kidney, coronary arteries, and mesenteries were removed for pathological observations with hematoxylin-eosin staining. As a result, multi-organ dysfunctions in the heart, brain, liver, kidney, vascular endothelium, and blood system were testified in the modeling rats at weeks 6 and 8. In conclusion, severe consequences of this animal model were highly similar to those in hypertensive crises emergencies, which could be further utilized in the early intervention of hypertensive crises emergencies including the possible risk factors control and efficient therapies assessment. Impact statement In the late 90s, numerous reports predicted that 1-2% of hypertensive individuals would undergo hypertensive crises (HPC) and figures reached as high as 7% when no antihypertensive therapies were administrated. Currently, clinical failures appear frequently due to the improper or excessive medication regimen instead of the illness itself. Therefore, early evaluations and observations of HPC on appropriate animal models ahead of patients should be discussed and emphasized more widely. In the present study, an appropriate animal model for HPC emergencies was firstly established, in which the consequences of long-term high-fat diet feeding followed by an acute vasoconstriction stress on the spontaneously hypertensive rats were experimentally testified. The proposed model would have a wide application prospects in early intervention of HPC emergencies including the controls of possible risk factors and assessments of efficient therapies.

Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature.

Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-specific symptoms, whereas heart-related symptoms (dyspnea, chest pain, arrhythmias, and syncope) are less common. Hypertensive crises can be divided into hypertensive emergencies or hypertensive urgencies according to the presence or absence of acute target organ damage, respectively. This differentiation is an extremely useful classification in clinical practice since a different management is needed, which in turn has a significant effect on the morbidity and mortality of these patients. Therefore, it is very crucial for the physician in the emergency department to identify the hypertensive emergencies and to manage them through blood pressure lowering medications in order to avoid further target organ damage or deterioration. The aim of this narrative review is to summarize the recent evidence in an effort to improve the awareness, recognition, risk stratification, and treatment of hypertensive crisis in patients referred to the emergency department.

Nursing care for women with pre-eclampsia and/or eclampsia: integrative review.

To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes. Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence. Analisar as evidências disponíveis na literatura sobre assistência de enfermagem às mulheres com pré-eclâmpsia e/ou eclâmpsia. Revisão integrativa cuja busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL, LILACS e SciELO. Amostra foi composta por 17 estudos primários, publicados entre janeiro de 2000 e dezembro de 2014, agrupados em quatro categorias: padronização da técnica de mensuração da pressão arterial; treinamentos com simulação; instrumentos para padronização da assistência e qualidade da assistência As principais ações de enfermagem foram: exame físico, identificação precoce de sinais de pré-eclâmpsia/eclâmpsia, acompanhamento de exames laboratoriais, avaliação fetal, capacitação e treinamento dos profissionais. Identificou-se a necessidade de padronização do atendimento a partir de instrumentos e protocolos e da técnica de aferição da pressão arterial, identificação e tratamento precoces da crise hipertensiva mediante protocolos institucionais e revisão de casos e processos de trabalho. Mulheres com pré-eclâmpsia e/ou eclâmpsia exigem cuidados de enfermagem específicos, os quais devem ser pautados em protocolos de cuidados baseados em evidências científicas.

Evaluation and treatment of hypertensive crises in children.

Hypertensive crises in children are medical emergencies that must be identified, evaluated, and treated promptly and appropriately to prevent end-organ injury and even death. Treatment in the acute setting typically includes continuous intravenous antihypertensive medications with monitoring in the intensive care unit setting. Medications commonly used to treat severe hypertension have been poorly studied in children. Dosing guidelines are available, although few pediatric-specific trials have been conducted to facilitate evidence-based therapy. Regardless of what medication is used, blood pressure should be lowered gradually to allow for accommodation of autoregulatory mechanisms and to prevent cerebral ischemia. Determining the underlying cause of the blood pressure elevation may be helpful in guiding therapy.

The Current Practice of Hypertensive Crises Treatment and the Underestimated Role of Clinical Pharmacists in Ambo Hospital Medical Ward, Ethiopia

Background: Hypertension is an extremely common clinical problem, affecting approximately 1 billion individuals worldwide. An estimated 1% to 2% of patients with chronic hypertension will at some time develop hypertensive crises (Hypertensive urgency and emergency). Hypertensive urgency and emergency are differentiated by the absence or presence of acute end-organ damage, respectively. The blood pressure of patients with hypertensive emergencies should be reduced rapidly during the treatment. It should not be reduced to the normal value, but by approximately 20-30% of the baseline value. The reason for a stepwise reduction in blood pressure is the fact that patients with chronic hypertension have an altered auto regulation curve. Case presentation: A 60 year old male patient, who has been a known hypertensive patient admitted due to sudden onset of body weakness, difficulty of speech, diverted lips towards the left side, difficulties in eating, moving, coughing and inability to move right side of his extremities since one day. On P/E the pt. was severely sick looking, and unconscious. Conclusion: A number of both parenteral and oral antihypertensive drugs can be used in these patients. Treatment of hypertensive crises in patients with hypertensive encephalopathy, intracranial haemorrhage, subarachnoid haemorrhage, and thrombotic stroke has been recommended to be initiated with nicardipine, fenoldopam, nimodipine, flunarizine or labetalol.

Sympathetic activity and arterial hypertension: potential for correction

The paper is focussed on the role of increased sympathetic activation in the pathogenesis of arterial hypertension (AH), its exacerbations (hypertensive crises), and complications. One of the effective methods of interrupting pathogenetic “vicious circles” in AH is the blockage of peripheral alpha-adrenoreceptors. One of the medications of choice for urgent treatment of hypertensive crises, as well as for long-term ambulatory treatment, is urapidil – a peripheral sympatholytic with characteristics of a central serotonin receptor agonist.

Oral nifedipine versus intravenous labetalol in hypertensive urgencies and emergencies of pregnancy: a randomized clinical trial.

Hypertensive crisis is an important cause of maternal and perinatal morbidity and mortality. To compare the efficacy of oral nifedipine and intravenous labetalol. One hundred women with hypertensive crisis were randomized to receive either oral nifedipine 10 mg or intravenous labetalol 20 mg. Oral nifedipine was given 10 mg stat followed by 10 mg every 30 minutes up to a maximum of 50 mg. Intravenous labetalol was given 20 mg stat followed by 40 mg 30 minutes later then two more doses of 80 mg every 30 minutes up to a maximum of 220 mg. The primary outcome was the number of doses required to achieve target blood pressure (BP) and time required to reduce the mean arterial pressure by 25%. Secondary outcomes analysed included additional drugs required, resurgence of hypertensive crisis. Data were analysed using repeated measures analysis of variance (ANOVA), mixed ANOVA, unpaired t-test and chi square test and P value ≤0.05 was considered significant. Systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) were lower than baseline at all time points of follow-up in both nifedipine and labetalol groups (P < 0.01). P < 0.05 by repeated measures ANOVA for overall trend of changes in SBP, DBP and MAP for within-group effects in both nifedipine and labetalol groups and P < 0.05 by mixed ANOVA for between-group effects during entire observation period. The magnitude of fall in SBP, DBP and MAP was greater in the labetalol group compared with the nifedipine group (P < 0.05). Target BP was achieved in 90% in the nifedipine group and 92% in the labetalol group. Maternal and fetal adverse effects were infrequent. Both oral nifedipine and intravenous labetalol are effective in the treatment of hypertensive crisis. Intravenous labetalol may have benefits because it is more effective in reducing the SBP, DBP and MAP to target levels with a lower number of doses.

Management of medical emergencies

Drawing on experience with emergencies presenting at King Edward VIII Hospital, this article provides a practical approach to the management of some of the commonest medical emergencies. It refers to recent advances in the treatment of Hypertensive crisis, Acute Pulmonary Oedema, Myocardial Infarction, Status Asthmaticus, Status Epilepricus and Hypoglycaemia.

DIHYDROPYRIDINE CALCIUM ANTAGONISTS. POSITION OF NIFEDIPINE IN MODERN CARDIOLOGY PRACTICE

Position of nifedipine in modern cardiology practice is highlighted. Nifedipine usage for arterial hypertension therapy , including combined one, stroke prevention, treatment of hypertensive crisis and ischemic heart disease is considered. Advantages of nifedipine innovative formulations are presented. Possible usage of nifedipine in pulmonary hypertension as well as pregnancy is discussed specially.

T15.6 Maternal fetal hemodynamics study before and after treatment of hypertensive crisis

T15.6 Maternal fetal hemodynamics study before and after treatment of hypertensive crisis

Pre-eclampsia treatment according to scientific evidence

Hypertensive disorders in pregnancy deserve special attention in the setting of global public health. Currently, they represent the third cause of maternal mortality in the world and first in Brazil. From a practical standpoint, pre-eclampsia remains a syndrome that leads to serious repercussions on maternal and fetal mortality and its etiology is not well known. Currently, the best treatment for forms of pre-eclampsia is being discussed at different times in pregnancy and puerperium, with the objective to reduce the high rates of maternal and fetal morbidity and mortality. Considering the pathophysiology of the event, anticipation of delivery is the best treatment for pre-eclampsia. The use of magnesium sulfate is recommended in all cases of severe pre-eclampsia and eclampsia for prevention and treatment of seizures. Likewise, treatment of hypertensive crises is recommended. Hydralazine, nifedipine and labetalol have been the most commonly used drugs for this purpose, but their use depends on the familiarity of the treating physician. Antenatal corticoid therapy is indicated whenever there is an imminent risk of preterm delivery between 24 and 34 weeks. In contrast, there is insufficient evidence to recommend bed rest and routine plasma volume expansion, and there is an urgent need for randomized clinical trials to determine whether maintenance antihypertensive treatment in pregnant women has benefits or risks for mothers and fetuses in all clinical forms of disease, particularly in cases of pure pre-eclampsia.

Urapidil, a dual-acting antihypertensive agent: Current usage considerations

Despite the availability of a wide range of effective blood pressure (BP)-lowering agents, a substantial proportion of patients with hypertension fail to achieve target BP levels. The majority of patients with hypertension need a combination of two or more drugs to achieve BP targets and choice of second-line or subsequent-line therapy is an important consideration in hypertension management. Alpha-1-adrenoreceptor antagonists (alpha-blockers) have a BP-lowering effect broadly similar to the other antihypertensive drug classes and are effective as add-on therapy in patients with inadequately controlled hypertension. Alpha-blockers may also have therapeutic benefits that go beyond BP control, including improvements in lipid profile and glucose metabolism, as well as reducing the symptoms of benign prostatic hyperplasia. Urapidil has an alpha-blocking effect but, unlike other alpha-blockers, also has a central sympatholytic effect mediated via stimulation of serotonin 5HT(1A) receptors in the central nervous system. Several studies have suggested that oral urapidil is effective and well tolerated when used as second-line therapy in patients with BP inadequately controlled with other agents. Urapidil has also been shown to improve glucose and lipid metabolism in hypertensive patients with concomitant diabetes and/or hyperlipidemia. Intravenous urapidil is effective in the treatment of hypertensive crises, perioperative hypertension, and pre-eclampsia and may have a potential role in the management of acute stroke. In this review, the use of alpha-blockers in hypertension is discussed, with particular focus on urapidil for the lowering of BP in a variety of clinical settings.

The Diagnosis and Treatment of Hypertensive Crises

Hypertension (HTN) is one of the most common chronic medical conditions, affecting nearly 72 million people in the United States. A systolic blood pressure (BP) > 180 mm Hg or a diastolic BP > 120 mm Hg is considered a “hypertensive crisis.” Hypertensive crises are categorized as either hypertensive emergencies or urgencies depending on the degree of BP elevation and presence of end-organ damage. The primary goal of intervention in a hypertensive crisis is to safely reduce BP. Immediate reduction in BP is required only in patients with acute end-organ damage (ie, hypertensive emergency). This requires treatment with a titratable short-acting intravenous (IV) antihypertensive agent, while severe HTN with no acute end-organ damage (ie, hypertensive urgency) is usually treated with oral antihypertensive agents.Patients with hypertensive emergencies are best treated in an intensive care unit (ICU) with titratable IV hypotensive agents. Rapid-acting IV antihypertensive agents are available, including clevidipine, labetalol, esmolol, fenoldopam, nicardipine, and sodium nitroprusside. Newer agents such as clevidipine have considerable advantages compared with other available agents in the management of hypertensive crises. Sodium nitroprusside is an extremely toxic drug, and its use in the treatment of hypertensive emergencies should be avoided. Likewise, nifedipine, nitroglycerin, and hydralazine should not to be considered first-line therapies in the management of hypertensive crises because these agents are associated with significant toxicities and/or side effects.