ABSTRACT
RESUMEN Introducción: los niveles de presión arterial por encima de las cifras normales aumentan el riesgo de padecer enfermedades cardiovasculares y cerebrales. Las complicaciones ocasionadas por las crisis hipertensivas son muy peligrosas y a menudo fatales. Es de suma importancia conocer bien sus características clínicas para tratar de contrarrestar su evolución. Objetivo: describir el comportamiento de las crisis hipertensivas en 500 pacientes del Servicio de Emergencias del Hospital de Clínicas, en el período de enero a junio de 2018. Metodología: estudio descriptivo y retrospectivo. Se utilizaron las hojas de recepción, acogida y clasificación de urgencias y las historias clínicas de pacientes ingresados con crisis hipertensivas. Se emplearon frecuencias absolutas y relativas (porcentaje) para resumir la información, y tablas para su presentación. Resultados: en el estudio predominó el sexo masculino, con 351 (70%) pacientes, y 149 (30%) de sexo femenino. El grupo etario en el que existió mayor predominio de pacientes (49%) fue el de 50-59 años de edad. Se observó un predominio de las urgencias hipertensivas con 399 (79,8%) pacientes, mientras que solo 101 (20,2%) pacientes desarrollaron emergencias hipertensivas. El órgano diana más frecuentemente dañado fue el cerebro en 43 (42,6%) pacientes con un accidente vascular cerebral, seguido por el síndrome coronario agudo en 34 (33,7%) pacientes. La alteración electrocardiográfica mas frecuente fue la hipertrofia del ventrículo izquierdo en 187 (37,4%) pacientes, y en segundo lugar se encontró el supradesnivel del ST, que se presentó en 111 (22,2%) pacientes. Conclusión: las complicaciones y los hallazgos más significativos en estos pacientes con crisis hipertensivas fueron los accidentes vasculares encefálicos y el síndrome coronario agudo, así como la hipertrofia del ventrículo izquierdo y la elevación del segmento ST dentro de las alteraciones electrocardiográficas.
ABSTRACT Introduction: Blood pressure levels above normal levels increase the risk of cardiovascular and cerebral diseases. Complications caused by hypertensive crises are very dangerous and often fatal. It is very important to know their clinical characteristics well to try to counteract their evolution. Objective: To describe the behavior of hypertensive crises in 500 patients of the Emergency Service of the Hospital de Clínicas, in the period from January to June 2018. Methodology: Descriptive and retrospective study. The reception and emergency classification sheets and the medical records of patients admitted with hypertensive crisis were used. Absolute and relative frequencies (percentage) were used to summarize the information, and tables for presentation. Results: In the study the male sex prevailed, with 351 (70%) patients, and 149 (30%) of female sex. The age group in which there was a greater prevalence of patients (49%) was 50-59 years old. A predominance of hypertensive urgencies was observed with 399 (79.8%) patients, while only 101 (20.2%) patients developed hypertensive emergencies. The most frequently damaged target organ was the brain in 43 (42.6%) patients with a stroke, followed by acute coronary syndrome in 34 (33.7%) patients. The most frequent electrocardiographic alteration was left ventricular hypertrophy in 187 (37.4%) patients, and in the second place was the ST elevation, which occurred in 111 (22.2%) patients. Conclusion: The most significant complications and findings in these patients with hypertensive crises were cerebrovascular accidents and acute coronary syndrome, as well as left ventricular hypertrophy and ST-segment elevation within electrocardiographic abnormalities.
ABSTRACT
Objective To observe the clinical effect of benzene sulfonic amlodipine combined with traditional Chinese medicine (TCM) Yangxueqingnao granules for treatment of patients with hypertensive urgencies (HU) with acute headache, and its effect on serum brain derived neurotrophic factor (BDNF) level.Methods A prospective study was conducted, 186 HU patients with acute headache admitted to the Department of Cardiology in the Affiliated Hospital of Southwest University from January 2014 to December 2016 were enrolled, and they were divided into a control group (90 cases) and an observation group (96 cases) by random number table method. The patients in control group received benzene sulfonic amlodipine (10 mg, once a day) and the patients in observation group were additionally given Yangxueqingnao granules (4 g, 3 times a day for consecutive 7 days) on the basis of treatment in control group. The mean arterial pressure (MAP), the nature and location of headache and the levels of serum BNDF were examined before and after treatment and compared between them in the two groups, the degree of headache was evaluated by visual analogue scale (VAS), and the clinical therapeutic effects in the two groups were observed.Results There were no statistical significant differences in MAP (mmHg, 1 mmHg = 0.133 kPa) between the two groups before treatment and at 2 hours, on 1, 3, 7 days after treatment (control group: 99.7±9.5, 94.2±9.1, 88.6±7.6, 81.8±9.3, 75.6±5.3 respectively, the observation group: 95.4±13.5, 91.2±8.1. 88.9±8.7, 83.2±8.6, 77.2±4.8 respectively, allP > 0.05). Compared with the control group, after treatment for 1, 3, 7 days, the nature of acute headache (dull pain, distending pain) was relieved more significantly, the number of patients with whole head headache was decreased more obviously in observation group [dull pain (cases): 16, 8, 3 vs. 28, 24, 18, distending pain (cases): 11, 6, 2 vs. 22, 16, 10, whole head pain (cases): 12, 5, 3 vs. 26, 20, 16, allP < 0.05]. With the prolongation of treatment, the VAS scores in the two groups were gradually decreased, on 7 days after treatment they reached to the lowest levels, and the degree of descent in the observation group was more significant than that in the control group (0.5±0.4 vs. 1.4±0.9,P < 0.05); thelevels of serum BNDF in the two groups were gradually increased after the 1st day of treatment, reached to the highest level on 7 days after treatment,and the degree of increase in observation group was more obvious than that in the control group (ng/L: 24.8±2.3 vs. 17.8±2.2). The therapeutic effective rate of the observation group was significantly higher than that of the control group [70.8% (68/96) vs. 53.3% (48/90),P < 0.05].Conclusion The combination of benzene sulfonic amlodipine and Yangxueqingnao granules can effectively relieve the acute headache in HU patients, and its mechanism is related to the increase in expression of BDNF.
ABSTRACT
La hipertensión arterial es un padecimiento caracterizado por un aumento persistente de la tensión arterial. La prevalencia en niños es significativamente menor que en adultos y fluctúa entre 1 y 3%. Se describen las cifras de normalidad en base al cuarto documento sobre diagnóstico, evaluación y tratamiento del National High Blood Pressure Education Program (NHBPEP). La hipertensión puede ser primaria o secundaria, cuando existe alguna causa, casi siempre es debida a enfermedades renales. El tratamiento depende de la causa y puede ser médico ( Cambio en el estilo de vida, farmacológico) o quirúrgico. A pesar de que la prevalencia de hipertensión arterial en la población pediátrica es baja, los casos de emergencia y urgencia hipertensiva pueden presentarse en el cuarto de urgencias. El manejo eficiente de estos niños es importante para evitar las complicaciones a largo plazo asociadas a la hipertensión y su tratamiento. La intención de este artículo consiste en revisar los aspectos más importante sobre la hipertensión arterial en pediatría, incluyendo definición, clasificación , emergencias y urgencias hipertensivas, manejo y pronóstico.
hypertension is a syndrome characterized by persistent elevation of blood pressure. Its incidence in children in lower than in adults, it fluctuates from 1 to 3%. It may be primary or secondary, secondary hypertension is mostly causes by renal diseases. We describe the classification based on the fourth document of the National High Blood Pressure Education Program and also describe the auxillary methods for the diagnosis of the etiology. The treatment depends on the cause which could be pharmacological or no pharmacological ( Changes in life style, antihyperntensive urgencies and emergencies may be encountered in the emergency department. Efficent managment of these children is of utmost importance to avoid some of the life-threatening complications associated with hypertension and its treatment. The scop of this article is to review some of the important aspects of pediatric hypertension , including definition, classification, diagnosis, hypertensive urgencies and emergencies, managment and outcome.
ABSTRACT
Objective To observe the effect of diliazem on cerebral oxygen metabolism during the period of blood pressure lowering in hypertensive urgencies.Methods 30 patients of hypertensive urgencies were randomized into two groups with 15 cases each.Group Ⅰ was administered with nitroglycerin.Group Ⅱ was administered with diliazem.Nitroglycerin was injected from 2.5?g/(kg?min).Group Ⅱ were received intravenous injection of diltiazem 5~10 mg,and then were continuously infusion by 5~15?g/kg/min with mictosyringe.Blood gas analysis was carried out by taking blood samples from right internal jugular vein bulb and radial artery,and D(a-jv)O2 and CEO2 were calculated before,during and after induced blood pressure lowering 0.5,1,2,3 hours.Results Compared with those in group Ⅰ,SjvO2 increased significantly in group Ⅱ(P0.05).Conclusion Diltiazem can decrease cerebral metabolism,improve oxygenation and play a role in cerebral protection in hypertensive urgencies.