Therapeutic Approach to Hypertensive Emergencies: Hemorrhagic Stroke.

Arterial hypertension represents the most important risk factor for ischemic and haemorrhagic stroke, and an acute hypertensive response is often observed in patients with intracranial haemorrhage (ICH). Available data indicate that the vast majority (> 70%) of patient with acute ICH have a systolic BP above 140 mmHg at the time of presentation in the ED; about 20% have SBP values above 180 mmHg. Severe BP elevation in the presence of ICH represents a hypertensive emergency, and worsening of clinical conditions is not infrequent in the first hours after admission; an aggressive early management is therefore required for these patients. Despite this, appropriate management of BP in acute ICH is still controversial, due to the complex issues involved, and the heterogeneous results obtained in clinical trials. This article will review the available evidence supporting acute BP reduction in acute ICH.

Definitions and Epidemiological Aspects of Hypertensive Urgencies and Emergencies.

Acute blood pressure (BP) elevation represents a frequent reason of concern for clinicians in everyday clinical practice. The terms "hypertensive emergencies" and "hypertensive urgencies" may be used in order to better define the so called "hypertensive crises". A hypertensive emergency may be defined as a condition characterized by an acute and severe elevation of blood pressure (BP) associated to a new onset or worsening organ damage (OD). A hypertensive urgency may be defined as a condition characterized by an isolated elevation of BP values without evidence of acute hypertensive OD. This article will review the definition, the prevalence, and the prognostic implications of hypertensive emergencies and urgencies.

Comparison of urapidil and nicardipine in the treatment of chronic renal failure patients with hypertensive emergencies / 药学实践杂志

Objective To study the efficacies and adverse reactions of urapidil and nicardipine in the treatment of the chronic renal failure patients with hypertensive emergencies .Methods 59 chronic renal failure patients with hypertensive emer-gencies were randomly divided into nicardipine treatment group and urapidil treatment group .The patients in the nicardipine group were given a 1 mg nicardipine intravenous injection ,and 30-100 μg/min intravenous transfusion was given continuously . The patients in the urapidil group were given a 12 .5 mg urapidil intravenous injection ,and 150-500μg/min intravenous trans-fusion was given continuously .The dosage were changed according to the patients′blood pressure in both of the groups .The patients′blood pressure ,heart rate and adverse reactions were recorded .Results The patients′blood pressure in both of the groups were significantly lower after treatment (P<0 .05) .The SBP in nicardipine treatment group was significant lower than SBP in urapidil treatment group in the first hour after treatment (P<0 .05) .There was no significant difference in SBP be-tween the two groups 2 hours after treatment (P>0 .05) .There was no significant difference in DBP between the two groups after treatment (P>0 .05) .In the nicardipine group ,the heart rate rose after the treatment ,the difference was statistically significant (P<0 .05) .While in the urapidil group ,the heart rate went down after the treatment ,and the difference was statis-tically significant (P<0 .05) .There was no significant difference in adverse reactions between the two groups (P>0 .05) . Conclusion Both of nicardipine and urapidil were effective in the treatment of chronic renal failure patients with emergency hy-pertensive .Nicardipine was more effective in reducing the SBP in the first stage of treatment .

Emergências hipertensivas e uso de drogas ilícitas / Hypertensive emergencies and use of illicit drugs

A hipertensão arterial (HA) secundária a substâncias ou drogas lícitas e ilícitas é um tipo de hipertensão com uma causa subjacente, potencialmente reversível. As drogas ilícitas podem interferir com os efeitos dos fármacos anti-hipertensivos, induzir emergências hipertensivas, precipitar eventos cardiovasculares e outras comorbidades. As principais drogas ilícitas associadas à hipertensão são: cocaína, crack, anfetaminas e seus derivados, como o ecstasy (MDMA). No Brasil, o consumo e o abuso de drogas vêm aumentando nos últimos anos, tornando-se um problema de saúde pública que atinge, em especial, adolescentes e adultos jovens, com grande impacto social e econômico para as famílias, no trabalho e no sistema de saúde. As emergências hipertensivas secundárias a drogas ilícitas podem ocorrer em indivíduos normotensos, hipertensos crônicos, resistentes, ou com lesões em órgãos-alvo preexistentes, as mais críticas. Os picos hipertensivos causados pela intensa ação simpaticomimética do abuso de drogas ilícitas são as principais causas da maioria das emergências e suas complicações. Na maioria das vezes, a reversão é obtida com a suspensão da droga ilícita, mas, em alguns casos, é necessária terapêutica endovenosa imediata, eficiente e individualizada, em Unidade de Terapia Intensiva. Este artigo revisa os aspectos epidemiológicos, fisiopatológicos, clínicos e terapêuticos das emergências hipertensivas e uso de drogas ilícitas, com destaque para as crises adrenérgicas, as metas pressóricas, os principais fármacos, suas ações e reações adversas.

Hypertension caused by substances or licit and illicit drugs is a type of hypertension with an underlying potentially correctable cause. Illicit drugs can interfere with the effects of antihypertensive drugs, induce hypertensive emergencies and may precipitate cardiovascular events and other co-morbidities. The main illicit drugs associated with hypertension are: cocaine, crack, amphetamines and derivatives, such as ecstasy (MDMA). In Brazil, the use and abuse of drugs have been increasing in recent years, becoming a public health problem that affects, in particular, adolescents and young adults, with major social and economic impact on families, at work and in the system health. Hypertensive crises secondary to illicit drugs may occur in normotensive, chronic hypertensive, resistant individuals, or those with pre-existing lesions in target organs, the most critical ones. The pressure peaks caused by the intense sympathomimetic action of the abuse of illicit drugs are the main causes of most emergencies and their complications. Most often, the reversal is obtained by removing of the illicit drug, but in some cases it is necessary immediate, efficient and individualized intravenous therapy in the Intensive Care Unit. This article reviews the epidemiological, pathophysiological, clinical and therapeutic aspects of hypertensive emergencies and the use of illicit drugs, especially adrenergic crises, blood pressure goals, the major drugs, their actions and adverse effects.

Labetalol vs.Nicardipine for Hypertension in Patients with Acute Aortic Dissection / 中国药房

0.05).After 30 minutes treatment,93% patients in labetalol group reached goal blood pressure(0.05).However,tachycardia was significantly(P