RESUMEN
The number of patients with arterial hypertension is continually increasing. Hypertension can cause organ complications, called hypertension-mediated organ damage (HMOD). One example is hypertensive retinopathy, in which high blood pressure (BP) damages both the retinal microcirculation and the retinal nerve fiber layer (RNFL). This can result in progressive and painless vision deterioration in some groups of patients. Unlike anywhere else in the human body, the microvasculature of the retina can be observed in vivo, and the progression of changes can be closely monitored. The harmful effect of increased BP on the eye is not only limited to hypertensive retinopathy, but can also lead to an exacerbation of diabetic retinopathy (DR) and to an increase in intraocular pressure (IOP), and it can also trigger the formation of thromboembolic lesions. This review presents an update on the pathogenesis of hypertensive retinopathy and the use of adaptive optics (AO) combined with optical coherence tomography (OCT) to evaluate the retinal microvasculature. The latest progress and directions of research in the field of hypertensive retinopathy are also discussed.
Asunto(s)
Retinopatía Hipertensiva/diagnóstico por imagen , Retinopatía Hipertensiva/patología , Tomografía de Coherencia Óptica/métodos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/patología , Retinopatía Hipertensiva/tratamiento farmacológicoRESUMEN
RESUMO O lúpus eritematoso sistêmico é uma doença que pode apresentar comprometimento oftalmológico geralmente benigno, sendo as alterações mais encontradas a síndrome do olho seco e a catarata. Nos pacientes com a doença estável, o dano oftalmológico parece estar relacionado ao tratamento sistêmico a longo prazo, o que enfatiza a importância do exame oftalmológico completo de rotina. Porém, quando a doença está em franca atividade e, em especial, quando há o envolvimento renal, deve-se iniciar o tratamento precoce com corticoterapia sistêmica e com medidas de suporte, para se evitarem repercussões mais complexas, como as crises hipertensivas que podem levar ao óbito.
ABSTRACT Systemic lupus erythematosus may present ophthalmological involvement, usually benign, and the most common changes are dry eye syndrome and cataract. In patients with stable disease, ophthalmologic damage appears to be related to long-term systemic treatment, emphasizing the importance of routine complete ophthalmologic examination. However, in full-blown disease, especially when there is renal involvement, early treatment should start with systemic steroid therapy and supportive measures, to avoid major repercussions, such as hypertensive crises that may lead to death.
Asunto(s)
Humanos , Femenino , Adolescente , Retinopatía Hipertensiva/etiología , Hipertensión Maligna/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Oftalmoscopía , Retina/diagnóstico por imagen , Prednisona/administración & dosificación , Agudeza Visual , Quimioterapia por Pulso , Retinopatía Hipertensiva/diagnóstico , Retinopatía Hipertensiva/tratamiento farmacológico , Microscopía con Lámpara de Hendidura , Fondo de Ojo , Hipertensión/complicaciones , Hipertensión/etiología , Hipertensión Maligna/etiologíaRESUMEN
Diabetes and hypertension are complex pathologies with increasing prevalence nowadays. Their interconnected pathways are frequently manifested in retinopathies. Severe retinal consequences and their tight connections as well as their possible treatments are particularly important to retinal research. In the present, work we induced diabetes with streptozotocin in spontaneously hypertensive rats and treated them either with PACAP or olaparib and alternatively with both agents. Morphological and immunohistochemical analyses were carried out to describe cell-specific changes during pathologies and after different treatments. Diabetes and hypertension caused massive structural and cellular changes especially when they were elicited together. Hypertension was crucial in the formation of ONL and OPL damage while diabetes caused significant differences in retinal thickness, OPL thickness and in the cell number of the GCL. In diabetes, double neuroprotective treatment ameliorated changes of calbindin-positive cells, rod bipolar cells and dopaminergic amacrine cells. Double treatment was curative in hypertensive diabetic rat retinas, especially in the case of rod bipolar and parvalbumin-positive cells compared to untreated or single-treated retinas. Our results highlighted the promising therapeutic benefits of olaparib and PACAP in these severe metabolic retinal disorders.
Asunto(s)
Diabetes Mellitus Experimental/tratamiento farmacológico , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Hipertensiva/tratamiento farmacológico , Polipéptido Hipofisario Activador de la Adenilato-Ciclasa/farmacología , Inhibidores de Poli(ADP-Ribosa) Polimerasas/farmacología , Células Amacrinas/efectos de los fármacos , Animales , Calbindinas/genética , Linaje de la Célula/efectos de los fármacos , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/patología , Retinopatía Diabética/genética , Retinopatía Diabética/patología , Modelos Animales de Enfermedad , Humanos , Retinopatía Hipertensiva/genética , Retinopatía Hipertensiva/patología , Ftalazinas/farmacología , Piperazinas/farmacología , Ratas , Ratas Endogámicas SHR/genética , Células Bipolares de la Retina/efectos de los fármacosRESUMEN
Abstract In kidney biopsies reviews, scleroderma renal crisis (SRC) is characterized by vascular endothelial injuries, C4d deposits on peritubular vessels, and acute and chronic injuries coexisting on the same biopsy. The clinical signs of thrombotic microangiopathy (TMA) are described in systemic sclerosis (SSc), nevertheless, it has not been related to acute injuries described on kidney biopsies. We report a case of SRC in a patient with scleroderma-dermatomyositis overlap syndrome, which also showed clinical and histopathological data of TMA. On fundus examination, a severe acute hypertensive retinopathy was found. The kidney biopsy showed severe endothelial damage with widening of mucoid cells at the level of the intima, focal concentric proliferation on most small arterioles, and C3, C4d, and IgM deposits along the capillary walls. The genetic study of complement only showed the presence of membrane cofactor protein (MCP) risk haplotypes, without other genetic complement disorders. We understand that in a patient with TMA and SSc, the kidney damage would be fundamentally endothelial and of an acute type; moreover, we would observe clear evidence of complement activation. Once further studies correlate clinical-analytical data with anatomopathological studies, it is likely that we will be forced to redefine the SRC concept, focusing on the relationship between acute endothelial damage and complement activation.
Resumo Nas revisões de biópsias renais, a crise renal esclerodérmica (CRE) é caracterizada por lesões endoteliais vasculares, depósitos de C4d em vasos peritubulares e lesões agudas e crônicas que coexistem na mesma biópsia. Os sinais clínicos de microangiopatia trombótica (MAT) são descritos na esclerose sistêmica (ES); no entanto, não foram relacionados às lesões agudas descritas nas biópsias renais. Relatamos um caso de CRE em um paciente com síndrome de superposição de esclerodermia-dermatomiosite, que também apresentou dados clínicos e histopatológicos de MAT. No exame de fundo do olho, foi encontrada uma retinopatia hipertensiva aguda grave. A biópsia renal mostrou lesão endotelial grave com alargamento das células mucoides ao nível da íntima, proliferação concêntrica focal na maioria das pequenas arteríolas e depósitos de C3, C4d e IgM ao longo das paredes dos capilares. O estudo genético do complemento mostrou apenas a presença de haplótipos de risco da proteína cofator de membrana (PCM), sem outros distúrbios genéticos do complemento. Entendemos que em um paciente com MAT e ES, o dano renal seria fundamentalmente endotelial e do tipo agudo; além disso, observaríamos evidências claras de ativação do complemento. Uma vez que novos estudos correlacionam dados clínico-analíticos com estudos anatomopatológicos, é provável que sejamos forçados a redefinir o conceito de CRE, enfocando a relação entre dano endotelial agudo e ativação do complemento.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Raynaud/complicaciones , Trastornos de la Visión/etiología , Lesión Renal Aguda/etiología , Riñón/irrigación sanguínea , Capilares/metabolismo , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Inmunohistoquímica , Papiledema/patología , Dermatomiositis/complicaciones , Dermatomiositis/inmunología , Retinopatía Hipertensiva/diagnóstico , Retinopatía Hipertensiva/patología , Retinopatía Hipertensiva/tratamiento farmacológico , Lesión Renal Aguda/diagnóstico , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiología , Riñón/patología , Riñón/diagnóstico por imagenRESUMEN
In hypertensive retinopathy, the retinal damage due to high blood pressure is accompanied by increased expression of Glial Fibrillary Acidic Protein (GFAP), which indicates a role of neuroinflammatory processes in such a retinopathy. Proteins belonging to the Rho GTPase family, particularly Rac1, are involved in the activation of Müller glia and in the progression of photoreceptor degeneration, and may thus represent a novel candidate for therapeutic intervention following central nervous system inflammation. In this paper, we have observed that topical administration as eye drops of Cytotoxic Necrotizing Factor 1 (CNF1), a Rho GTPase modulator, surprisingly improves electrophysiological and behavioral visual performances in aged spontaneously hypertensive rats. Furthermore, such functional improvement is accompanied by a reduction of Rac1 activity and retinal GFAP expression. Our results suggest that Rac1 inhibition through CNF1 topical administration may represent a new strategy to target retinal gliosis.
Asunto(s)
Toxinas Bacterianas/uso terapéutico , Proteínas de Escherichia coli/uso terapéutico , Gliosis/tratamiento farmacológico , Retinopatía Hipertensiva/tratamiento farmacológico , Retina/efectos de los fármacos , Visión Ocular/efectos de los fármacos , Animales , Toxinas Bacterianas/administración & dosificación , Modelos Animales de Enfermedad , Proteínas de Escherichia coli/administración & dosificación , Gliosis/fisiopatología , Retinopatía Hipertensiva/fisiopatología , Masculino , Soluciones Oftálmicas , Ratas , Ratas Endogámicas SHR , Retina/fisiopatologíaRESUMEN
In kidney biopsies reviews, scleroderma renal crisis (SRC) is characterized by vascular endothelial injuries, C4d deposits on peritubular vessels, and acute and chronic injuries coexisting on the same biopsy. The clinical signs of thrombotic microangiopathy (TMA) are described in systemic sclerosis (SSc), nevertheless, it has not been related to acute injuries described on kidney biopsies. We report a case of SRC in a patient with scleroderma-dermatomyositis overlap syndrome, which also showed clinical and histopathological data of TMA. On fundus examination, a severe acute hypertensive retinopathy was found. The kidney biopsy showed severe endothelial damage with widening of mucoid cells at the level of the intima, focal concentric proliferation on most small arterioles, and C3, C4d, and IgM deposits along the capillary walls. The genetic study of complement only showed the presence of membrane cofactor protein (MCP) risk haplotypes, without other genetic complement disorders. We understand that in a patient with TMA and SSc, the kidney damage would be fundamentally endothelial and of an acute type; moreover, we would observe clear evidence of complement activation. Once further studies correlate clinical-analytical data with anatomopathological studies, it is likely that we will be forced to redefine the SRC concept, focusing on the relationship between acute endothelial damage and complement activation.
Asunto(s)
Lesión Renal Aguda/etiología , Riñón/irrigación sanguínea , Enfermedad de Raynaud/complicaciones , Trastornos de la Visión/etiología , Lesión Renal Aguda/diagnóstico , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Capilares/metabolismo , Dermatomiositis/complicaciones , Dermatomiositis/inmunología , Humanos , Retinopatía Hipertensiva/diagnóstico , Retinopatía Hipertensiva/tratamiento farmacológico , Retinopatía Hipertensiva/patología , Inmunohistoquímica , Riñón/diagnóstico por imagen , Riñón/patología , Masculino , Persona de Mediana Edad , Papiledema/patología , Enfermedad de Raynaud/patología , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/inmunología , Resultado del Tratamiento , Trastornos de la Visión/diagnósticoRESUMEN
PURPOSE: To investigate factors associated with long-term visual outcome in cats with hypertensive chorioretinopathy. ANIMALS STUDIED: Eighty-eight client-owned cats diagnosed with hypertensive chorioretinopathy. PROCEDURE: Medical records from cats with systemic hypertension and associated retinal lesions were reviewed. RESULTS: Most cats (61%) were blind in both eyes at presentation. Presence of menace response at last follow-up evaluation was positively correlated with presence of menace response at presentation (P = .0025), time to complete retinal reattachment (P < .0001), and gender (P = .0137). Seventy-six of 132 eyes (57.6%) that were blind at presentation regained some vision following treatment. At the time of last evaluation, 101/176 eyes (60%) had a positive menace response, while 34/46 (74%) eyes with a follow-up of >6 months had a positive menace response. Eyes that had a menace response at presentation were 17 and 37 times more likely to have a menace response at last examination compared to eyes blind for less than 2 weeks and eyes blind greater than 2 weeks, respectively. Female cats were overrepresented (62.5% of cases), and male cats were 4.2 times more likely to be visual at time of last examination compared to female cats. CONCLUSIONS: With treatment, the prognosis for long-term vision in cats with hypertensive chorioretinopathy, even following complete retinal detachment, is good.
Asunto(s)
Antihipertensivos/uso terapéutico , Enfermedades de los Gatos/tratamiento farmacológico , Enfermedades de la Coroides/veterinaria , Hipertensión/veterinaria , Retinopatía Hipertensiva/tratamiento farmacológico , Retinopatía Hipertensiva/veterinaria , Amlodipino/uso terapéutico , Animales , Benzazepinas/uso terapéutico , Ceguera/veterinaria , Gatos , Enfermedades de la Coroides/tratamiento farmacológico , Enfermedades de la Coroides/etiología , Femenino , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Retinopatía Hipertensiva/etiología , Masculino , Pronóstico , Resultado del Tratamiento , Visión OcularRESUMEN
A young female suffering from chronic kidney disease presented with retinal features suggestive of retinitis pigmentosa (RP). Cystoid intraretinal changes were noted at the macula in both eyes on optical coherence tomography. Careful clinical examination and fluorescein angiography revealed disc oedema, macular hard exudates and flower petal leakage in both eyes. A clinical diagnosis of RP with leaking cystoid macular oedema (CMO) because of hypertensive retinopathy was made. Exudation and macular oedema subsided with hypertension control and posterior sub-Tenon steroid injection. Although CMO does not typically leak on fluorescein angiography in RP, this need not always be true. Clinical signs and fluorescein angiography help in the differentiation of macular oedema when more than one aetiology may be responsible.
Asunto(s)
Retinopatía Hipertensiva/complicaciones , Retinopatía Hipertensiva/diagnóstico , Retinitis Pigmentosa/complicaciones , Retinitis Pigmentosa/diagnóstico , Adulto , Antiinflamatorios/uso terapéutico , Antihipertensivos/uso terapéutico , Diagnóstico Diferencial , Femenino , Angiografía con Fluoresceína , Humanos , Retinopatía Hipertensiva/tratamiento farmacológico , Retina/diagnóstico por imagen , Retinitis Pigmentosa/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Tiofenos/uso terapéutico , Tomografía de Coherencia Óptica , Triamcinolona Acetonida/uso terapéutico , Adulto JovenRESUMEN
Hypertensive retinopathy is seen frequently in patients with systemic hypertension and is usually asymptomatic. An acute rise in blood pressure may lead to exudative changes in the form of macular edema, hemorrhages, and serous macular detachment that can lead to visual decline. The authors report prompt resolution of exudative changes in a case of hypertensive retinopathy following intravitreal bevacizumab.
Asunto(s)
Bevacizumab/administración & dosificación , Retinopatía Hipertensiva/tratamiento farmacológico , Retina/diagnóstico por imagen , Agudeza Visual , Inhibidores de la Angiogénesis/administración & dosificación , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Retinopatía Hipertensiva/diagnóstico , Inyecciones Intravítreas , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Adulto JovenRESUMEN
A congenital bladder diverticulum (CBD) is caused by inherent muscular weakness instead of obstruction of the bladder outlet. The major clinical conditions are recurrent urinary tract infection (UTI) and voiding dysfunction. This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. The cause of hypertension was bilateral obstructive uropathy caused by enlarged paraureteral bladder diverticula. After the non-functioning right kidney and ureter and the bilateral diverticula were removed, the left ureter was reimplanted in the bladder. Pathologic findings showed chronic pyelonephritis and partial loss of the bladder musculature in the diverticular wall. This observation indicates that dilated CBD can cause latent UTI, ureteral obstruction, hydronephrosis, and secondary hypertension.
Asunto(s)
Divertículo/diagnóstico , Retinopatía Hipertensiva/patología , Obstrucción Ureteral/diagnóstico , Vejiga Urinaria/anomalías , Adolescente , Antihipertensivos/uso terapéutico , Atenolol/uso terapéutico , Creatinina/sangre , Divertículo/congénito , Humanos , Retinopatía Hipertensiva/tratamiento farmacológico , Riñón/diagnóstico por imagen , Masculino , Pielonefritis/patología , Recurrencia , Tomografía de Coherencia Óptica , Tomografía Computarizada por Rayos X , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Infecciones Urinarias/diagnósticoRESUMEN
El síndrome de leucoencefalopatía posterior reversible se presenta con síntomas de edema cerebral e imágenes hiperintensas en las secuencias T2 y FLAIR en la resonancia magnética (RM) de cerebro. Las lesiones típicamente comprometen la región parietooccipital, aunque también pueden tener localizaciones atípicas. Presentamos el caso de una mujer de 33 años que consultó por trastornos visuales asociados con dolor de cabeza intenso e hipertensión grave (220/140 mmHg). El examen del fondo de ojo reveló retinopatía hipertensiva grado IV y la RM mostró lesiones hiperintensas en T2 y FLAIR a nivel centropontino, bulbo y médula espinal, las cuales regresaron tras el control sostenido de la presión arterial. (AU)
The posterior reversible leukoencephalopathy syndrome presents with symptoms of cerebral edema. On magnetic resonance imaging (MRI) of the brain, hyperintensities on T2 -weighted and FLAIR sequences typically affect the parietal-occipital region; however it may also have atypical locations. We report the case of a 33 year old patient with visual disturbances associated with intense headache and severe hypertension (220/140 mmHg). The Fundus examination revealed grade IV hypertensive retinopathy, and MRI showed hyperintense lesions in T2 and FLAIR affecting the pontine center, medulla and spinal cord, which regressed after sustain blood pressure control. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Médula Espinal/diagnóstico por imagen , Cerebro/diagnóstico por imagen , Síndrome de Leucoencefalopatía Posterior/diagnóstico por imagen , Retinopatía Hipertensiva/diagnóstico por imagen , Médula Espinal/patología , Trastornos de la Visión , Imagen por Resonancia Magnética , Cerebro/patología , Síndrome de Leucoencefalopatía Posterior/tratamiento farmacológico , Retinopatía Hipertensiva/tratamiento farmacológico , Imagen Óptica , Hipertensión/tratamiento farmacológico , Antihipertensivos/uso terapéuticoRESUMEN
A 15-year-old girl presented with acute bilateral loss of central visual acuity due to hypertensive retinopathy level IV. She was found to have unrecognized malignant arterial hypertension associated with end-stage renal failure. At the time of diagnosis she also had severe left ventricular hypertrophy (LVH). Hypertension was successfully treated with combined anti-hypertensive therapy, but renal function did not recover. The patient underwent successful kidney transplant 4 months later and over a period of 20 months hypertensive retinopathy and LVH gradually resolved. This report emphasizes the importance of routine measurement of blood pressure and describes the possible consequences of unrecognized arterial hypertension in children. Early diagnosis and appropriate treatment are necessary to avoid development and progression of target organ damage and promote better long-term cardiovascular prognosis.
Asunto(s)
Ceguera/etiología , Hipertensión Maligna/complicaciones , Retinopatía Hipertensiva/complicaciones , Fallo Renal Crónico/complicaciones , Adolescente , Antihipertensivos/uso terapéutico , Presión Sanguínea , Femenino , Humanos , Hipertensión Maligna/tratamiento farmacológico , Retinopatía Hipertensiva/diagnóstico , Retinopatía Hipertensiva/tratamiento farmacológico , Hipertrofia Ventricular Izquierda/etiología , Fallo Renal Crónico/cirugía , Trasplante de RiñónRESUMEN
We aimed to determine the prevalence and risk factors of retinopathy in hypertensive outpatients. Demographic data, accompanying diseases, anthropometric measurements, and blood and urine biochemistry of 655 hypertensive patients were evaluated. Hypertensive retinopathy rate was 66.3% (grade 1, 33.6%; grade 2, 32.7%). Age, duration of hypertension, and systolic blood pressure levels were significant risk factors for retinopathy (P = .048, P = .035, and P = .012, respectively). Any correlations between retinopathy and gender, body mass index, biochemistry, and associated diseases were not found. This study shows that the degree and duration of hypertension increases the incidence of retinopathy. Low-grade retinopathy seems not to be associated with other cardiovascular risks.
Asunto(s)
Retinopatía Hipertensiva/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea , Comorbilidad , Femenino , Humanos , Retinopatía Hipertensiva/tratamiento farmacológico , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
PURPOSE: Malignant hypertensive retinopathy is a rare, but serious, complication of uncontrolled systemic hypertension for which no treatment has been established yet. We report 2 patients with malignant hypertensive retinopathy who recovered promptly following intravitreal bevacizumab injection. METHODS: Intravitreal bevacizumab (1.25 mg/0.05 mL) was injected in 4 eyes of 2 patients having malignant hypertensive retinopathy with optic disc edema, macular edema, and retinal exudates. A complete ophthalmic examination, including the best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT), and fluorescein angiography (FAG), was performed before and after the treatments. RESULTS: Two eyes in 1 patient received two intravitreal injections of bevacizumab, whereas 2 eyes in the other patient received a single treatment. All 4 eyes had improvement of macular edema on OCT at 1 month and decreased fluorescein leakage on FAG 3 months after the treatment, which led to improvements in the BCVA in 3 eyes. In 1 eye with foveal atrophy, no change in the BCVA occurred despite the improved macular edema on OCT. CONCLUSIONS: The results suggest that intravitreal bevacizumab injections might be a useful adjunctive treatment of malignant hypertensive retinopathy in some selected cases. However, further studies are mandatory to determine the safety and the efficacy of such injections in this disease.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Hipertensión Maligna/tratamiento farmacológico , Retinopatía Hipertensiva/tratamiento farmacológico , Adulto , Bevacizumab , Femenino , Humanos , Inyecciones Intravítreas/métodosRESUMEN
Hypertensive crises are divided into hypertensive urgencies and emergencies. Together they form a heterogeneous group of acute hypertensive disorders depending on the presence or type of target organs involved. Despite better treatment options for hypertension, hypertensive crisis and its associated complications remain relatively common. In the Netherlands the number of patients starting renal replacement therapy because of 'malignant hypertension' has increased in the past two decades. In 2003, the first Dutch guideline on hypertensive crisis was released to allow a standardised evidence-based approach for patients presenting with a hypertensive crisis. In this paper we give an overview of the current management of hypertensive crisis and discuss several important changes incorporated in the 2010 revision. These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. With regard to the treatment of hypertensive emergencies, nicardipine instead of nitroprusside or labetalol is favoured for the management of perioperative hypertension, whereas labetalol has become the drug of choice for the treatment of hypertension associated with pre-eclampsia. For the treatment of hypertensive urgencies, oral administration of nifedipine retard instead of captopril is recommended as first-line therapy. In addition, a section on the management of hypertensive emergencies according to the type of target organ involved has been added. Efforts to increase the awareness and treatment of hypertension in the population at large may lower the incidence of hypertensive crisis and its complications.