Author/Editor		Čegovnik, Borut; Dobovišek, Jurij
Title		Hipertenzivna nujna stanja na terenu in v ambulanti splošne medicine - smernice
Translated title		Hypertension emergencies and urgencies in primary care environment - guidelines
Type		članek
Source		In: Bručan A, Gričar M, editors. Urgentna medicina: izbrana poglavja 6. Zbornik 7. mednarodni simpozij o urgentni medicini; 2000 jun 14-17; Portorož. Ljubljana: Slovensko združenje za urgentno medicino,
Publication year		2000
Volume		str. 189-97
Language		slo
Abstract		Hypertensive emergency or crisis is the physical state where high blood pressure is accompanied by the symptoms of high blood pressure and/or target organ damage. It is only in this circumstance that measures to lower blood pressure must be applied immediately. When dealing with such emergencies the mean blood pressure must be lowered by 20-25%, or the diastolic BP decreased to 100 mm Hg, immediately, or within no more than two hours. We apply this treatment more gradually and carefully to those patients who have previously suffered chronic hypertension: otherwise it can be applied aggressively. When treating urgencies, mean blood pressure is brought down to the abovementioned levels over a one to two day period, but in the case of cerebrovascular accident we make an exception: we only lower extremely high blood pressure over the first two to three days. Alongside the level of blood pressure we always assess the critical state of the patient: mental status, cardiovascular and pulmonary status and any neurological deficit, as a minimum. For emergencies an ECG and examination of eye fundi is carried out as a standard. Currently, the drug we favour for the rapid lowering of blood pressure is captopril, in doses of 6.25 mg up to 50 mg. We also use clonidin, propranolol, prazosin and rapidly acting sublingual nitroglycerin. Nifedipine is no longer recommended, but could be used as a last resort, except in the case of older people with target organ damage where it is extremely inadvisable. Dosages can be administered in a short acting regimen of 2.5 mg to 5 mg every 15 to 20 min, or of 10 mg to 20 mg in the case of classic retard formulation. In the primary care environment outside of hospital the only parenteral drug available is enalaprilat in dosages of 1.25 mg to 5 mg to be administered through slow intravenous injection. The treatment should always be started with a lower dosage, and then maintained at six hours intervals. (Abstract trunated at 2000 characters).
Descriptors		HYPERTENSION HYPERTENSION, MALIGNANT CORONARY DISEASE RISK ASSESSMENT CAPTOPRIL NIFEDIPINE ENALAPRIL CEREBROVASCULAR DISORDERS ANEURYSM, DISSECTING AORTIC ANEURYSM HEART FAILURE, CONGESTIVE PHEOCHROMOCYTOMA DRUG INTERACTIONS CLONIDINE SUBSTANCE WITHDRAWAL SYNDROME COCAINE NITROGLYCERIN AMBULATORY CARE