17:47,16,Feb,2011 | (809/0/0) | Original

hypertensive crisis emedicine


Overview Pinyin: gāo xuè yā wēi xiàng English: hypertensive crisis
Hypertensive crisis Hypertensive crisis means the occurrence of hypertension during a special clinical phenomenon, also seen in symptoms of hypertension. It is the basis of hypertension, transient occurred around the strong contraction of small arteries, leading to sharp rise in blood pressure results. Can occur in slowly into the various types of hypertension (especially the first and second), can also be found in the radical type of hypertension. Hypertensive crisis is an extremely critical of the symptoms, often under the influence of adverse incentives, the blood pressure suddenly rose to 26.6/16 kPa (200/120 mm Hg) or more, appear in heart, brain and kidney damage in acute critical symptoms. Patient felt a sudden headache, dizziness, blurred vision or blindness; nausea, vomiting, palpitation, shortness of breath, pale or flushed; hands shake, irritability; serious a temporary paralysis, aphasia, angina, urine turbid ; heavier then convulsions, coma. Hypertensive crisis occurs in the course of the disease in patients with hypertension as a special clinical phenomenon, it is based on high blood pressure, certain incentives for temporary strongly around the small artery in spasm, causing a sharp rise in blood pressure further, and appear the performance of a hypertensive crisis. And in the short span of time irreversible damage to vital organs, it is a fatal clinical syndrome. Hypertensive crisis can occur at all levels of hypertensive patients with slow progress, but also found in a variety of aggressive hypertension. Changes in the clinical manifestations of consciousness, severe headache, nausea, vomiting, tachycardia, pale, breathing difficulties, and its dangerous condition, such as rescue measures ineffective, can lead to death. Pathogenesis of the pathogenesis of hypertensive crisis, most scholars believe is the predisposing factor for hypertension patients under the action of circulating renin, angiotensin â…¡, to norepinephrine and arginine vasopressin in contraction vasoactive substances sudden abrupt increases, the afferent renal artery caused by contraction or expansion of such a situation continued to exist, in addition to the rapid increase in blood pressure can lead to stress and more outside of urine, and subsequent reduction of blood volume reduction in circulating blood volume , also caused reflex angiotensin â…¡, norepinephrine and arginine vasopressin production and release of increasing the circulation of blood and blood vessels of vasoactive substances toxic to dangerous levels, thereby increasing the renal artery contraction. Due to the small arteries due to contraction and expansion of cross-district, so its was "sausage string"-like change. Caused by small artery intimal injury and platelet aggregation, thromboxane and other harmful substances led to the further release of platelet thrombus formation, causing tissue ischemi
a and hypoxia, increased capillary permeability, accompanied by spotting microvascular coagulation and necrosis of small arteries inflammation to the brain and kidney damage is most obvious atherosclerosis and vascular spasm in particular can lead to increased intimal hyperplasia of small arteries, thus forming a vicious cycle of pathological (Figure 1) In addition, sympathetic nerve hyperactivity and vascular compression of the active substance not only caused by excessive secretion of the renal arteries and can cause the body around the small artery spasm, leading to a sudden increase in peripheral vascular resistance, the blood pressure further increased risk of hypertension at this time. The pathogenesis of hypertensive crisis induced by factors of trauma, mood changes, fatigue, cold stimulation, climate change and endocrine disorders (such as the menopause or menstrual period) and so on.
Hypertensive crisis secondary to a predisposing factor in hypertension: renovascular hypertension is secondary hypertension of the most common include: acute and chronic glomerulonephritis, chronic pyelonephritis (late effects to the kidney function ), renal artery stenosis, kidney stones, kidney tumor. Aortic stenosis, Takayasu go far. Brain lesions that may also cause increased intracranial pressure secondary to hypertension. Pathological generation: (a) hypertensive encephalopathy includes two processes, one for the functional changes that cerebral vasodilation, excessive cerebral blood flow in brain tissue, causing hypertensive encephalopathy; the other for the organic changes that acute arterial wall injury, fibrinoid necrosis. (B) small artery disease of the kidneys and other organs, arteries and arterioles of acute vascular disease, intimal injury, promote platelet aggregation, fibrin deposition, intimal cell proliferation, microvascular thrombosis. (C) of the renal damage caused by severe hypertension renal vascular damage, renal ischemia caused by renin - angiotensin system, renin secretion, blood vessel contraction, aldosterone secretion, thereby increasing blood volume and blood pressure higher. (D) microvascular coagulation microangiopathic hemolytic anemia, with red blood cell fragmentation and intravascular coagulation. (E) pregnancy-induced hypertension by animal experiments and clinical observation that perfusion of the placenta during pregnancy to reduce the uterus to make prostaglandins (PGE) synthesis in the uterus decreased, thus contributing to increased renin secretion by angiotensin system to blood pressure increased. Sudden onset of clinical manifestations, the condition dangerous. Usually presents severe headache, accompanied by nausea and vomiting, visual impairment and mental and neurological abnormalities. Main features: 1, blood pressure increased significantly: systolic blood pressure up to 200mmHg or more, severe diastolic blood pressure was also significantly higher than .2 up to 117mmHg, autonomic dysfunction syndrome: a sense of fever, sweating, dry mouth, chills, Hand, Foot and tremor, palpitations and other 3, the performance target organ of acute injury: (1) blurred vision, loss of vision, fundus examination showed retinal hemorrhage, exudates and papilledema; (2), chest tightness, angina, palpitations, shortness of breath, cough, sputum and even slightly foam; (3), urinary frequency, oliguria, serum creatinine and urea nitrogen levels; (4) a transient sensory disturbances, hemiplegia, aphasia. severe restlessness or lethargy. Clinical manifestations: the original of such diseases collectively known as hypertensive emergency, in 1984, the International Joint Commission needs to be divided according to the treatment called for the immediate treatment and to allow reduced requirements in the short term target level of two kinds, in 1997 JNCVI unified risk for hypertension like, and according to target organ damage and the need for immediate antihypertensive treatment of hypertensive crisis is divided into the acute and sub-acute hypertension. Hypertensive emergency (hypertensiveemergencies): refers to high blood pressure associated with target organ damage in acute progressive diastolic blood pressure often ≥ 18.3kPa (130mmHg), require immediate antihypertensive treatment (but do not need to normal range) to prevent or reduce target organ damage often need intravenous medication. Including: ① hypertensive encephalopathy; ② rapidly progressive / malignant hypertension associated with heart, brain, kidney fundus
Hypertensive crisis damage. ③ hypertension and intracranial hemorrhage / subarachnoid hemorrhage; ④ hypertension and acute renal failure; ⑤ hypertension and acute left ventricular failure / pulmonary edema; ⑥ hypertension and unstable angina and acute myocardial infarction; ⑦ Acute aortic dissection; ⑧ eclampsia; ⑨ pheochromocytoma, etc., the specific Table 1. Hypertensive sub-acute (hypertensiveurgencies): also known as hypertension urgency status, means increased blood pressure and no severe acute target organ damage. Allows lower blood pressure within hours of intravenous drug use do not necessarily need Jian, allows oral medication. Mainly include: ① the radical type / malignant hypertension unintentional brain and kidney damage eyes; ② pre-eclampsia; ③ perioperative hypertension. Common in elderly hypertensive emergency are the following: 1, hypertensive encephalopathy (1), hypertensive encephalopathy (hypertensiveencephalopathy) is defined in the course of hypertension in the acute blood circulation, causing cerebral edema and increased intracranial pressure and produced a series of clinical manifestations, as long as any type of blood pressure was significantly elevated blood pressure, can cause hypertensive encephalopathy, but more common in past clinical and normal blood pressure suddenly hypertension, pregnancy-induced hypertension such as acute glomerulonephritis comprehensive levy, etc., also good type of fat in the aggressive or seriously slow into the hypertensive patients with significant cerebral arteriosclerosis. In addition to a sudden increase in blood pressure, often accompanied by severe headache and consciousness outside sometimes appear to change physical activity barriers, fundus examination have limitations or diffuse retinal artery spasm, but not necessarily bleeding, oozing or swelling can be quickly restored after antihypertensive treatment . Hypertensive encephalopathy in the course of hypertension, a serious complication is a common medical emergency, one should be in the event of irreversible brain damage before dying, immediate diagnosis and aggressive treatment of otherwise easily lead to death rescue. (2) The etiology and pathogenesis: the incidence of hypertensive encephalopathy, depending on the height and blood pressure increase speed. The former condition is an important contributing factor to the latter. Hypertensive encephalopathy may be caused by a variety of disease associated with hypertension, is characterized by a long history of hypertension and vascular sclerosis associated with significant brain more susceptible to hypertension, which occurred in the aggressive disease and severe hypertension ease into the hypertensive patients, the latter generally a serious condition, blood pressure increased significantly. Blood pressure is about more than just occurred in 250/150mmHg, but aggressive type of blood pressure in hypertensive patients does not meet the 200/130mmHg also occur when the hypertensive encephalopathy. In addition, it reported pregnancy-induced hypertension, glomerulonephritis, renal artery stenosis, pheochromocytoma and other secondary hypertension as long as the moderate increase in blood pressure, but also the possibility of occurrence of hypertensive encephalopathy. Rare cause of aortic stenosis and primary aldosteronism disease processes. The pathogenesis of hypertensive encephalopathy complicated still not very clear. Most scholars believe that the occurrence of autoregulation of cerebral circulation disorders related. Under normal circumstances, cerebral blood flow in a fairly large fluctuations of blood pressure to maintain a constant cerebral artery diameter in size, characterized by dynamic changes are not dependent on the autonomic nervous system regulation, but the cerebral artery wall directly on the diastolic and systolic blood pressure response to . When blood pressure drops, the expansion of cerebral small artery to ensure blood supply to the brain will not decrease. When the blood pressure increased, cerebral small artery contraction of the brain blood flow is not overly filling. This allows blood flow has remained relatively stable and fluctuations are within the physiological range. Such regulation, however there is a limit, when the mean arterial blood pressure more than 160mmHg or below the upper limit of 60 ~ 70mmHg, the brain function of small arteries to the loss of this regulation, often makes the blood pressure in hypertensive patients the clearance rate of occurrence of change. 2, intracranial hemorrhage (1), including intracranial hemorrhage and brain parenchymal intraventricular hemorrhage: Hypertension is the most important cause of intracranial hemorrhage in one. The relationship between hypertension and cerebral hemorrhage than in hypertension and atherosclerosis more closely. Hypertension, cerebrovascular disease does not necessarily rule out the possibility of cerebral contrast, in the absence of hypertension is not likely to cause intracerebral hemorrhage: ① vasospasm or vascular occlusion caused by softening of the brain, reducing the support of the vascular tissue around rupture strength of the blood vessel is easy; ② nourishing blood vessels rupture, the formation of arterial wall in a small small aneurysm in the high pressure of blood to the outer wall and into the surrounding brain tissue ulceration; ③ miliary aneurysm rupture, but in the absence of cerebrovascular disease patients whose brain rarely found in miliary aneurysm; ④ functional disorder of blood vessels caused by vascular spasm of oxygen, so that even the capillary wall necrosis and venous bleeding. (2) The need to identify pre-treatment of brain hemorrhage and infarction in CT diagnosis. Angiography confirmed the bleeding site of vascular spasm, blood pressure can lead to decreased cerebral blood perfusion, blood pressure in this case is controversial. If the blood pressure generated when the focal neurological symptoms or worsening, so blood pressure should not drop too quickly or too low. Common type (a) sudden hypertensive encephalopathy a sharp rise in blood pressure, severe vascular disease can cause brain edema, neurological symptoms, headache was the initial complaint, vomiting, visual disturbances, papilledema, altered mental status, the pathological appears , convulsions,
The pathogenesis of hypertensive crisis and coma. Cerebrospinal fluid pressure up to 3.92kPa (400mmH2O), protein increased. The effective antihypertensive treatment, blood pressure, can quickly ease the symptoms. (B) of the hypertensive crisis associated with intracranial hemorrhage, including intracerebral hemorrhage or subarachnoid hemorrhage. (C) of the hypertensive crisis caused by the sudden release of catecholamines found in pheochromocytoma. The tumor can produce and release a large number to norepinephrine and epinephrine, a common tumor in the adrenal medulla, but also in other parts of the organization with pheochromocytoma, such as the aortic bifurcation, such as chest and abdominal sympathetic ganglia. Showed a sharp increase in blood pressure, with tachycardia, headache, pale, sweating, numbness, hand, foot and cold. Attack several minutes to several hours. Incentives to stimulate the onset of some patients, such as emotion, exercise, push the tumor, urine, sneezing and so on. Intermittent episodes may be asymptomatic. Through the onset of urinary catecholamine metabolites VMA and the determination of blood catecholamines can be diagnosed the disease. (D) of hypertensive crisis with acute pulmonary edema (e) of hypertensive crisis with renal impairment (VI) hypertensive crisis associated with aortic dissection (vii) pregnancy-induced hypertension in late pregnancy hypertension, proteinuria and edema, severe enough to cause eclampsia. 1 auxiliary examination, blood 2, 3 urine, renal function 4, CT laboratory: attack a small amount of urine protein and red blood cells, blood urea nitrogen, creatinine, blood glucose increased.
Other auxiliary examination of hypertensive crisis: fundus examination with retinal hemorrhage and exudation. Hypertensive encephalopathy secondary inspection: 1, fundus examination showed hypertensive fundus features, showing diffuse retinal artery spasm or limitation of highly hardened or bleeding, exudation, and optic disc edema. 2, there may be limitations of EEG abnormalities or bilateral synchronous sharp slow wave, sometimes poor performance of rhythm. Therefore, due to cerebral edema, often diffuse slow wave appears. 3, CSF pressure was significantly increased. Test results more than the normal number of red blood cells or leukocytes occasionally, a slight increase in protein content. Differential diagnosis (1) pheochromocytoma with typical episode of paroxysmal hypertension, intermittent episodes of blood pressure to normal. Step-down test positive, urine catecholamine 3-methoxy-4- hydroxy acid but bitter apricot (VMA) levels increased, renal pelvis and retroperitoneal contrast imaging can help identify inflated. (2) when the symptoms of hypertensive encephalopathy brain tumors and brain tumors similar to the need to be identified. Brain tumor patients with optic disc edema and signs of intracranial lesions, X-ray and CT examination can help identify. (3) The incidence of intracranial hemorrhage consciousness disorder often sudden, deep breathing with snoring sounds, mouth askew and limb paralysis. Fundus examination may have papilledema, but no retinal artery spasm performance. Treatment of acute hypertension optimal treatment of the principle of treatment is both rapid decline in blood pressure to safe levels to prevent progressive or irreversible target organ damage; can not
Classification of hypertensive crisis or excessive blood pressure drop too fast, otherwise it would cause local or systemic hypoperfusion. A variety of treatment strategies for a hypertensive emergency, hypertensive encephalopathy 2, 3, cerebral vascular accident, acute aortic dissection 4 pheochromocytoma 5, eclampsia of pregnancy (1) hypertensive encephalopathy, and aortic dissection is in need of emergency buck. They are basically the same principles of treatment, generally about 25% of first drop in blood pressure as well, the blood pressure before maintained at 160/100mmHg appropriate. preferred nitroprusside. nitroglycerin on coronary heart disease, cardiac insufficiency are particularly applicable. Secondly available diazoxide, clonidine, labetalol can also be used (2) Department of pheochromocytoma due to hypertensive crisis, may be the preferred phentolamine. until systolic blood pressure dropped to 180mmHg, diastolic blood pressure dropped to 110mmHg gradually reduce, and maintained with oral antihypertensive drugs. (3) _ with left ventricular failure: the preferred nitrate P sodium, supplemented by diuretics such as furosemide, should avoid the use of several similar sympathetic blockers. (4) hypertension and acute cerebrovascular disease: blood pressure should be careful, not a sharp step-down. for the treatment of intracranial hemorrhage There are some disputes. intracerebral hemorrhage in only antihypertensive treatment when systolic blood pressure more than 200mmHg, the general reduced to 150mmHg appropriate. ischemic cerebral vascular accident, such as cerebral infarction, antihypertensive treatment in general should not, unless the blood pressure is very high, such as diastolic blood pressure> 130mmHg, and diastolic blood pressure dropped to 100mmHg as to the good. (5) pregnancy eclampsia: magnesium sulfate can be used, as well as hydralazine and so on. If hydralazine does not work, try labetalol. antihypertensive drugs with caution : antihypertensive hydralazine, calcium antagonists, sodium nitroprusside. Avoid the use of drugs: the top three thiophene side, β-blockers, angiotensin-converting enzyme inhibitors, diuretics. hypertensive emergency blood pressure lowering drugs 1, nitroprusside sodium Nitroprusside2, nitroglycerin Nitroglycerin3, nicardipine Nicardipine4, esmolol Esmolol5, urapidil Urapidil6, diltiazem Diltiazem7, diazoxide Diazoxide8, phentolamine Phentolamine9, reserpine Reserpine10, nifedipine Nifedipine11, clonidine Clonidine12 , Captopril captopril onset of the symptoms usually last for short and rapid recovery, but easy to relapse. Attack can have a small amount of urine test red blood cells and protein, blood urea nitrogen in muscle and crisp, free of epinephrine or norepinephrine may increase, during and after the onset of seizures can increase blood sugar. Fundus examination may have bleeding, oozing or papilledema. The crisis of hypertension during a severe symptoms, the condition dangerous, especially with hypertension encephalopathy, acute heart failure or acute renal failure, the onset of symptoms once the need for timely and effective measures be taken, or can lead to death. Definition 1, hypotension on hemodynamics in acute hypertension, high blood pressure caused by acute symptoms and functional changes of the body can be attributed to high blood pressure, the heart, brain and kidney damage has been proved effective control of hypertension, can prevent or reverse the damage by anti-hypertensive effect of this is to improve hemodynamics in patients with hypertensive emergency achieved. (1) the role of blood pressure on the brain: an effective antihypertensive treatment can improve brain function, especially in patients with hypertensive encephalopathy is more obvious, when the decline in blood pressure when appropriate, cerebral vasodilation, cerebral blood flow and metabolism to properly maintained. However, excessive blood pressure drop can cause a sharp decline in cerebral blood flow in cerebral ischemia produced significant clinical prone to dizziness, and even dizziness or fainting. (2) the role of blood pressure on the heart: acute treatment of hypertension in some antihypertensive drugs, especially complicated in patients with refractory angina pectoris and heart failure benefit, the results show that the lower blood pressure, improve blood supply in favor of coronary heart while improved hemodynamic monitoring also confirmed that patients with heart failure - pulmonary artery pressure and right ventricular myocardial blood flow and the ratio between metabolic demand, it is so intractable angina under control at the same time, the general symptoms of heart failure with blood pressure The downward pressure also decreased significantly. (3) blood pressure on kidney function: When the abrupt decline in blood pressure when the glomerular filtration rate and renal blood flow also decreased. Since no increase in glomerular filtration rate, renal function has not improved it, but clinical observation showed that severe hypertension associated with renal insufficiency buck is not taboo, but be careful, step-down Kaishi not too fast, does not require to normal, and urine output should be maintained in the 1L a day or more. More than 120mmHg or diastolic blood pressure in progressive renal damage occurs. In summary, we can see the rapid antihypertensive therapy hypertensive emergency, through the hemodynamic changes
Good laboratory hypertensive crisis can be improved to alleviate the symptoms of hypertension to prevent complications in patients with rapidly deteriorating conditions, play a positive role in blood pressure. 2, treatment of hypertensive emergency, some scholars have proposed the determinants of diastolic blood pressure> 140mmHg is one of the clinical characteristics of hypertensive crisis, but Sesoko et al study showed that aggressive type of malignant hypertension and in patients with systolic hypertension absolute pressure and diastolic blood pressure was significant overlap. This shows the degree of blood pressure to form the radical-type malignant hypertension is undoubtedly important factor but it is not an absolute factor. Again, patients with hypertension complicated by acute left ventricular failure, acute aortic dissection hematoma and intracerebral hematoma, even if only a moderate increase in blood pressure, but also a serious threat to patients with life. In view of this many scholars outside of China believe that the decision constitutes a hypertensive emergency have high blood pressure factor was not the cause but the degree of blood pressure, high blood pressure in particular the speed and the existence of complications, increased blood pressure, the absolute value of these more more important, so that the treatment of hypertensive emergency key issue is the choice of available antihypertensive drugs, blood pressure control in the security level, and its purpose is to prevent acute target organ damage. 3, treatment of hypertensive crisis treatment of elderly hypertensive crisis precautions should be noted that the speed and extent of blood pressure, not one-sided pursuit of quick buck do not have to be completely normal, the patient heart, brain and kidney functional status and The concept of perfusion rarely considered to be abandoned, should be emphasized that the following step-down of the individual factors affected the choice of route of administration of drug doses and lower blood pressure goals. Because hypertension patients first aid fatigue, mood swings, trauma and other incentives, in the long or short period of time so that a sharp increase in blood pressure, rapid deterioration of the disease known as hypertensive crisis. Patients before severe headache, dizziness, blurred vision, if not in time, the condition will worsen, and then change occurs consciousness, nausea, vomiting, abdominal pain, vomiting, abdominal pain, breathing difficulties, heart palpitations and so on. Appeared severe, convulsions, coma, angina, heart failure, renal failure, cerebral hemorrhage and other serious consequences. When the symptoms of patients with hypertension immediately after the above absolute bed rest, and taking nifedipine, blood pressure music, reserpine and other fast antihypertensive drugs, and stability of 10 mg. Forbidden to take aminophylline, ephedrine and other stimulants, or vasodilators. At the same time call an ambulance as soon as possible to the nearest hospital system in the treatment. Prevention: Hypertension patients should adhere to the medication, and often to the hospital for monitoring of blood pressure changes, timely adjustment of drug dose. Normally should arrange the work and rest, not overwork, to ensure adequate sleep. Give up smoking, alcohol and high fat diet, have a greater emotional wave to avoid complications of high blood pressure during hypertensive crisis is a serious symptom, the condition dangerous, especially with hypertension encephalopathy, acute heart failure or acute renal failure, once the onset of symptoms or the need for timely and effective measures taken can lead to death. Common sense to prevent hypertensive crisis, is a high risk of cardiovascular Intensive. Shall immediately receive timely, effective treatment. Where once the blood pressure in hypertensive patients and associated with abrupt increase in heart, brain, kidney and other major organ dysfunction should be immediately to the hospital for specialist treatment to prevent serious complications. Antihypertensive treatment system, avoid over exertion and mental stimulation, prevention measures will help significantly reduce the incidence of hypertensive crisis. Condition should be gradually stabilized over to conventional antihypertensive treatment and the long-term adherence. Patients with hypertensive crisis Hypertensive emergency as fatigue, mood swings, trauma and other incentives, in the long or short period of time so that a sharp increase in blood pressure, rapid deterioration of the disease known as hypertensive crisis. Patients before severe headache, dizziness, blurred vision, if not in time, the condition will worsen, and then change occurs consciousness, nausea, vomiting, abdominal pain, vomiting, abdominal pain, breathing difficulties, heart palpitations and so on. Appeared severe, convulsions, coma, angina, heart failure, renal failure, cerebral hemorrhage and other serious consequences. When the symptoms of patients with hypertension immediately after the above absolute bed rest, and taking nifedipine, blood pressure music, reserpine and other fast antihypertensive drugs, and stability of 10 mg. Forbidden to take aminophylline, ephedrine and other stimulants, or vasodilators. At the same time call an ambulance as soon as possible to the nearest hospital system in the treatment. Prevention: Hypertension patients should adhere to the medication, and often to the hospital for monitoring of blood pressure changes, timely adjustment of drug dose. Normally should arrange the work and rest, not overwork, to ensure adequate sleep. Give up smoking, alcohol and high fat diet, to avoid large fluctuations in mood. First aid treatment of emergency treatment of hypertensive crisis are: 1. The patients sent to a quiet room, supine position,
Hypertensive crisis to give comfort. 2. Nitroprusside use of drugs to lower blood pressure a few seconds of steel work, drug use by doctors directly; Buck miles a few minutes work, doctors should master the dose i reserpine, methyldopa, atmospheric set work hours, age of drugs according to different use. Blood pressure in elderly hypertensive crisis should be slow and orderly, step-down level of the safety 21. 3kPa ~ 24.okPa/13 · 3kPa ~ 14.7kPa (160mmHg ~ 180InmHg/ID0mmHg ~ 110mmHg), began to step-down dose should be small, the diastolic blood pressure drop 160kPa (120mmHg). 3. Immediately taken to hospital patients into the CCU or ICU treatment. 4. Use of drugs to prevent brain edema, such as mannitol, furosemide and other treatment. Convulsions, the appropriate use of sedatives. Such as stability, phenobarbital, chloral hydrate and so on. 5. Anti-heart failure treatment such as use of vasodilators. 6. Hemodialysis treatment of azotemia. 7. Pheochromocytoma hypertension increases, to be elected a receptor antagonist phentolamine treatment. In conclusion, hypertensive crisis is not an ordinary family dealing with the object and places, access to hospital is required. Rescue methodology of hypertensive crisis, time is life, be sure to make quick buck measures, rescue patients. Therapeutic purposes, as soon as possible so that blood pressure blood pressure enough to stop the brain, kidney, heart and other target organ for damage, but do not result in the level of hypoperfusion of vital organs. Choice of the following measures: ⑴ SNP: 30 ~ 100mg, 5% glucose solution, 500ml, dark as intravenous drip drip rate 0.5 ~ 10μg (kg · min), should be used to monitor blood pressure, adjust according to blood pressure Disu. ⑵ diazoxide: 200 ~ 300mg, in the vein injection of 15 ~ 30s, 2h after the injection when necessary. Combined treatment with furosemide to prevent Shuinazhuliu. ⑶ Labetalol: 20mg slow intravenous injection, if necessary, injected once every 10min, until a satisfactory outcome, or until the total dose of 200mg. ⑷ phentolamine: 5mg slow intravenous injection, mainly for the hypertensive crisis of pheochromocytoma. ⑸ artificial hibernation: chlorpromazine 50mg, promethazine 50mg and sent for pyridine 100mg, add 500ml of 10% glucose solution intravenously, can also use the half dose. ⑹ on blood pressure was significantly increased, but symptoms are not severe, can be used sublingual nifedipine 10mg, captopril 12.5 ~ 25.0mg. Or oral prazosin 1 ~ 2mg, 0.1 ~ 0.2mg clonidine or Camino to Haier. Also intravenous diltiazem or nicardipine. Low blood pressure should not be too fast. Blood pressure control, the need of oral antihypertensive drugs, or continue to maintain the efficacy of antihypertensive drugs injected. Diagnostic criteria of stroke and coronary heart disease high blood pressure is an independent risk factor, the level of the prognosis and hypertension, other cardiovascular risk factors and the degree of target organ damage. As a guide treatment and prognosis, according to prognostic factors (high blood pressure levels, other cardiovascular risk factors, diabetes, target organ damage and complications), and make risk stratification in patients with hypertension, the table below 2:
Blood pressure (mmHg) other risk factors and history of an SBP 140 ~ 159 or DBP 90 ~ 992   SBP 160 ~ 179 or DBP 100 ~ 1093   SBP ≥ 180 or DBP ≥ 110 without other risk factors for high risk low risk of 1 or 2 risk a risk factor in the risk of a very high risk of ≥ 3 risk factors or a dangerous risk of diabetes, target organ damage or risk a very high risk of complications very high risk of a very high risk of very high-risk low-risk, medium risk, high risk, very high risk, respectively, the heart will occur within 10 years , cerebrovascular disease event probability <15%, 15% to 20%, 20% to 30% and> 30%. Non-hazardous low, medium, high; in the, middle, high, high, full-high 1. For the risk stratification of cardiovascular risk factors include: â‘  the level of systolic and diastolic blood pressure (1 ~ 3); â‘¡ Age: male> 55 years, women> 65 years; â‘¢ smoking; â‘£ total cholesterol> 5.72mmol / L (220mg/dl); ⑤ diabetes; â‘¥ family history of premature cardiovascular disease (age of onset of male <55 years old, female <65 years). 2. Target organ damage in clinical situations include: â‘  left ventricular hypertrophy (electrocardiogram, echocardiogram, or X ray). â‘¡ proteinuria and (or) serum creatinine level increased slightly (106 ~ 177μmol / L or 1.2 ~ 2.0mg/dl). â‘¢ ultrasound or X ray confirmed that atherosclerotic plaques (carotid, iliac, femoral or aortic). â‘£ general or focal retinal artery.
hypertensive crisis emedicine

Hypertensive crisis (hypertension crisis) is the primary and secondary hypertension in the development of the disease process, in some incentives, the sharp rise in blood pressure (diastolic blood pressure above 140mmHg or systolic blood pressure higher than 220mmHg, the disease deteriorated sharply as a result of hypertension-induced heart, brain, kidney and other target organ dysfunction and often life-threatening complications. hypertension refers to high blood pressure 230/130Hg acute or more, but without acute target organ damage and other complications appears. In addition, if diastolic blood pressure higher than that of 140Hg blockade should be regarded as symptoms of a hypertensive crisis. hypertensive crisis, often the clinical neurological disorders, cardiovascular disease, other diseases and medical education classification of hypertensive emergencies Collecting network. now all causes Diagnosis of hypertension risk points and symptoms, treatment, note the way a list representation.
1. Nervous system diseases: hypertensive encephalopathy, intracranial hemorrhage, subarachnoid hemorrhage, severe hypertension with acute cerebral infarction bar.
2. Cardiovascular disease: acute left heart failure, pulmonary edema, acute aortic dissection, unstable angina or acute myocardial infarction with severe hypertension. Source: Medical Education Network www.med66.com
3. Other lesions: eclampsia, pheochromocytoma, acute renal failure and severe hypertension.
4. Hypertensive Emergency: aggressive type of malignant hypertension, catecholamine excess syndrome (such as the withdrawal syndrome) perioperative hypertension.
(A) of hypertensive encephalopathy
1. Diagnostic criteria and symptoms
(1) blood pressure 250/150mmHg Collecting Medical Education Network
(2) increased intracranial pressure, cerebral edema, headache, dizziness, nausea, vomiting, convulsions, coma spontaneously.
2. Treatment
(1) 0.5 ~ 10ug/min intravenous sodium nitroprusside (immediate effect) Collecting Medical Education Network
(2) 50 ~ 150mg/min diazoxide injection (1 ~ 2min work)
(3), labetalol given 20 ~ 80mg/min intravenous injection (5 ~ 10min work)
(4) 5 ~ 100ug/min nitroglycerin intravenous injection (2 ~ 5min work)
3. Notes
Within 1 hour mean arterial pressure decreased by 20% to 25% is appropriate, or reduced to 100mmHg, with caution diuretics and central inhibition drugs such as clonidine.
(B) subarachnoid hemorrhage
1. Diagnostic criteria and symptoms
(1) systolic blood pressure> 180mmHg
(2) have severe headache, nausea, vomiting
(3) meningeal irritation, cranial nerve palsy to the side of the common
(4) lumbar puncture: cerebrospinal fluid pressure increased, the three bloody uniform
(5) CT examination, cerebral angiography shows subarachnoid hemorrhage
2. Treatment
(1) nimodipine 40 ~ 80mg / d oral
Or nimodipine 45ng/kg/min glucose dissolved in 250ml of 5% intravenous infusion (intravenous conditional micro pump available).
(2) 20% mannitol 250ml 5mg intravenous dexamethasone. (Note: It is now commonly used in small amount of mannitol)
(3) a large number of hemostatic agents: general use 6 aminocaproic acid 24g / d, in two intravenous infusion.
(4) pain, pain
(5) Surgical
3. Notes
6 to 12-hour mean arterial pressure decreased by 20% to 25%, lower systolic blood pressure target level of 140 ~ 160mmHg
Bleeding
1. Diagnostic criteria and symptoms
(1) age over 50 years old
(2) blood pressure 250/150mmHg, a severe headache, nausea, vomiting, rapid coma
(3) papilledema, but no arterial spasm, pinpoint pupils, difficulty breathing
(4) lumbar puncture: cerebrospinal fluid was bloody
(5) CT, MRI prompted parenchymal hemorrhage (high density)
2. Treatment
(1) diastolic blood pressure> 140mmHg when the intravenous use of sodium nitroprusside
(2) blood pressure> 230/120mmHg, labetalol given 100-200mg orally, or given labetalol 200mg 200ml normal saline intravenously (2mg/min), piracetam 4.0-8.0g 5% intravenous glucose 500ml drip
(3) blood pressure 180-230/105-120mmHg, given oral labetalol, nifedipine, captopril 12.5mg-25mg, 30min after the blood pressure, no improvement could be replaced by labetalol given ,20-80mg intravenous Xie
(4) blood pressure <180/105mmHg not buck
(5) dehydrating agent: 20% mannitol 250ml dexamethasone 5mg infusion, infusion 1500-2000ml / d, attention was potassium and water and electrolyte balance (excluding dehydrating agent)
(6) to prevent complications
(7) surgery
3. Notes
Blood pressure to reduced 160-170/100mmHg appropriate.
(D) of hypertensive cerebral infarction
1. Diagnostic criteria and symptoms
(1) patients with hypertension and arteriosclerosis
(2) the higher age of majority
(3) headache is not heavy, most of the conscious
(4) hemiplegia, aphasia and other focal symptoms
(5) ct check appears low density 24-48h
(6) normal cerebrospinal fluid
2. Treatment
(1) oral nimodipine ,40-80mg / d
(2) low molecular weight dextran 500-1000ml intravenous drip
(3) low molecular weight heparin
(4) Chinese Medicine: Mailuoning 20-30ml 5% glucose infusion 250ml, 1 times / day
(5) oral aspirin 300mg / day
.
The names of diseases of hypertensive crisis: hypertensive crisis respective areas: the systemic treatment department: Department of Cardiology, signs and symptoms: visual disturbances, fever, speech impairment, paralysis, cough, nausea and vomiting, oliguria About hypertensive crisis
Benign and malignant hypertension can be divided into two types, also known as aggressive type of malignant hypertension, diastolic blood pressure is high, causing a small renal necrotizing arteritis, azotemia, if not treated, about a year die of malignant hypertension in the original The incidence of
hypertension in 1%. Knowledge of hypertensive crisis cause hypertensive crisis: the incentive of the disease is mainly mental trauma, mood changes, fatigue, cold . the symptoms of hypertensive crisis: a sudden onset of the patients with multiple, dangerous condition, usually presents severe headache, hypertensive crisis . check: Once the onset of the disease in serious condition, and harm the system more, so check . the differential diagnosis of hypertensive crisis: The disease needs with the following the differential diagnosis of some diseases: (1) pheochromocytoma hypertensive crisis . Prevention: Prevention of common sense: hypertensive crisis, is a high risk of complications of hypertensive crisis effort .: High blood pressure during hypertensive crisis is a symptom of a serious, dangerous disease, . the treatment of hypertensive crisis: (a) decreased blood pressure as soon as possible. (B) select the medication according to the condition of hypertensive crisis related articles .
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