ABSTRACT
Hypertension is an exceedingly common disorder in Western societies; but, thanks to improved management of chronic hypertension, the number of patients who present with hypertensive crisis (HC) is less than 1%. However, critical elevation of blood pressure (BP) obliges to a proper and immediate management in order to prevent serious injury to organ target of hypertension (brain, heart, kidney and vessels). Moreover, the so called hypertensive emergencies (HE) and the hypertensive urgencies (HU) expect a several therapeutic approach. The HE warrant both prompt admission to an intensive care unit, where it is available a continuous monitoring of BP, and a prompt starting of a therapy with parenteral anti-hypertensive drugs. The treatment of HU can be managed choosing oral anti-hypertensive agents followed by a tight observation of the patient also in ambulatory system, lowering the BP more gradually over 12 to 24-48 hours. The present clinical review is aimed at reporting the current opinions on the management of HC, examining as well the drugs of largest use. Any drug that lowers BP precipitously should be avoided. Choice of the appropriate agent should be based on the underlying pathophysiological and clinical findings, on the mechanism of action, and on its potential side effects.
Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension, Malignant/drug therapy , Acute Disease , Adult , Aged , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Antihypertensive Agents/classification , Case Management , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/physiopathology , Child , Coronary Disease/complications , Coronary Disease/physiopathology , Critical Care/methods , Eclampsia/drug therapy , Eclampsia/physiopathology , Emergencies , Female , Humans , Hypertension, Malignant/complications , Hypertension, Malignant/diagnosis , Hypertension, Renal/complications , Hypertension, Renal/drug therapy , Hypertensive Encephalopathy/etiology , Hypertensive Encephalopathy/prevention & control , Illicit Drugs/adverse effects , Infant, Newborn , Male , Monitoring, Physiologic , Pre-Eclampsia/drug therapy , Pre-Eclampsia/physiopathology , PregnancyABSTRACT
Enteric infections in childhood are estimated to be a primary cause of illness and death in the third world and Rotaviruses play a very important role in acute nonbacterial diarrheal enterocolitis. The Authors analyse the latest results of the direct investigation of the virus in the feces by ELISA method. The improvements in diagnostic techniques and the new knowledges about Rotaviruses and their pathogenic power acquired during the last decade have made it easier to know the consequences of Rotavirus infections particularly in the poorest countries, with very bad sanitary conditions. Much attention has therefore been paid to the study of dietetics and immunoprophylaxis in order to find the most suitable cure. At present only some vaccines of animal origin are available that many Authors consider to be harmless, and that, might hopefully be employed in the third world countries.
