Arterial hypertension “urgency” vs “emergency”: terminology, differential diagnosis and treatment issues
M.D. Smirnova
National Medical Research Center of Cardiology, Moscow
The article is devoted to modern concepts of emergency and urgent conditions associated with hypertension. The primary task in determining the therapeutic approach to a patient with a hypertensive crisis is to evaluate the target organs condition. If an acute lesion of the target organs is suspected, the patient is recommended emergency hospitalization in an intensive care unit (complicated hypertensive crisis). Medical care is provided on an outpatient basis in an uncomplicated crisis. The following oral antihypertensive drugs with short-term action are administrated: captopril, moxonidine, nifedipine, clonidine, propranolol and etc. Aggressive BP reduction in patients with severe asymptomatic hypertension can lead to complications and should be avoided. The BP reduction rate should not exceed 25% for the first 2 hours, with the follow-up achievement of the target blood pressure within a few hours, but not more than 24 hours from the therapy start. Next, it is necessary to conduct the selection or correction of basic antihypertensive therapy. The drug of choice can be captopril, which has broad indications for administration, a relatively small number of restrictions and a good safety profile. The same drug can be used for premedical first aid in hypertensive crises as it is characterized by an optimal rate and BP reduction level. Prescription of short-acting antihypertensive drugs is not appropriate for asymptomatic severe hypertension. Basic therapy correction is recommended.
Keywords: arterial hypertension, emergency and urgent conditions, target organ lesion, antihypertensive drugs.
For citation: Smirnova M.D. Arterial hypertension “urgency” vs “emergency”: terminology, differential diagnosis and treatment issues. RMJ. Medical Review. 2019;1(II):77–82.
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4. Sundström J., Arima H., Jackson R. et al. Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med. 2015;162(3):184‒191.
5. Gauer R. Severe Asymptomatic Hypertension: Evaluation and Treatment. Am Fam Physician. 2017;95(8):492‒500.
6. Anderson C.S., Heeley E., Huang Y. et al. INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–2365.
7. Qureshi A.I., Palesch Y.Y., Barsan W.G. et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–1043.
8. Lee M., Ovbiagele B., Hong K.S. et al. Effect of blood pressure lowering in early ischemic stroke: meta-analysis. Stroke. 2015;46:1883–1889.
9. Jauch E.C., Saver J.L., Adams H.P. Jr. et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.
10. Grossman A., Messerli F.H., Grossman E. Drug induced hypertension — An unappre-ciated cause of secondary hypertension. Eur J Pharmacol. 2015;763:15– 22.
11. McNaughton C.D., Self W.H., Zhu Y. et al. Incidence of hypertension-related emergency department visits in the United States, 2006 to 2012. Am J Cardiol. 2015;116(11):1717‒1723.
12. Patel K.K., Young L., Howell E.H. et al. Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting. JAMA Intern Med. 2016;176(7):981‒988.
13. Nakprasert P., Musikatavorn K., Rojanasarntikul D. et al. Effect of predischarge blood pressure on follow-up outcomes in patients with severe hypertension in the ED. Am J Emerg Med. 2016;34(5):834‒839.
14. Grassi D., O’Flaherty M., Pellizzari M. et al. Group of Investigators of the REHASE Program. Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles. J Clin Hypertens (Greenwich). 2008;10(9):662–667.
15. Baumann B.M., Cline D.M., Pimenta E. Treatment of hypertension in the emergency department. J Am Soc Hypertens. 2011;5(5):366–377.
16. Varon J., Elliott W.J. Management of severe asymptomatic hypertension (hypertensive urgencies) in adults. UpToDate. (Electronic resource). URL: https://www.uptodate.com/contents/management-of-severe-asymptomatic-hypertension-hypertensive-urgencies-in-adults (access date: 05.04.2019).
17. Indarawis D. Acute management of severe asymptomatic hypertension Clinician Reviews. 2017;27(11):40‒46.
18. Чазов Е.И., Беленков Ю.Н., Борисова Е.О. и др. Рациональная фармакотерапия сердечно-сосудистых заболеваний. Руководство для практикующих врачей. М.: Литтера; 2006. [Chazov E.I., Belenkov Yu.N., Borisova E.O. et al. Rational pharmacotherapy for cardiovascular diseases. A guide for practitioners. M .: Litter; 2006 (in Russ.)].
19. Филиппова О.В. Кризовое течение артериальной гипертензии на догоспитальном этапе: алгоритм ведения пациента. РМЖ. 2018;1(II):76–81. [Filippova O.V. Hypertensive crisis at the prehospital stage: patient management algorithm. RMJ. 2018;1(II):76–81 (in Russ.)].
20. Gemici K., Baran I., Bakar M. et al. Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial Doppler ultrasonography during hypertensive crisis. Blood Press. 2003;12:46‒48.
21. Житникова Л.М. Артериальная гипертония: курс на эффективное комбинированное лечение. РМЖ. 2011;26:1667. [Zhitnikova L.M. Hypertension: a course for effective combined treatment. RMJ. 2011;26:1667 (in Russ.)].
22. Рунихин А.Ю., Рагозин А.К., Ткачева. Лечение артериальной гипертонии у пациентов с метаболическим синдромом. РМЖ. 2016;9:579–584. [Runikhin A.Yu., Ragozin AK, Tkachev. Treatment of arterial hypertension in patients with metabolic syndrome. RMJ. 2016;9:579–584 (in Russ.)].
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