* For medical professionals reading reference only
Listen to Professor Li Nanfang Talk about the diagnosis, treatment and prevention of " hypertension crisis "
Talking about hypertension , everyone is familiar with it. As a chronic disease, it has occupied half of the common underlying diseases for the elderly and even middle-aged and young people. But "common" does not mean that its harm is low, especially because of the hypertension crisis caused by it, which often occurs urgently and is severely ill, which directly threatens the patient's life.
is on October 8, 2022 " National Hypertension Day ", and Medical Cardiovascular Channel specially invited a conversation with experts from Cardiovascular Health Alliance. This time, we were fortunate to invite Professor Li Nanfang, director of the High Blood Pressure Center of the People's Hospital of Xinjiang Uygur Autonomous Region and the Key Laboratory of Hypertension Clinical Research of the National Health Commission. discussed in-depth discussions with us on "Hypertension Crisis Management", in order to improve the diagnosis and treatment level of high blood pressure by Chinese clinicians and help patients further understand the relevant knowledge of hypertension.
The hypertension crisis is "severeering than a tiger".
can only be diagnosed with symptomatic treatment
Professor Li Nanfang pointed out that the hypertension crisis is one of the most serious complications of hypertensive patients, including hypertension acute and hypertension subacute .
High blood pressure acute refers to the clinical manifestations of severe elevated blood pressure (usually blood pressure >180/120mmHg) accompanied by progressive damage to the target organ, including hypertensive encephalopathy , intracranial hemorrhage, acute myocardial infarction , acute left heart failure with pulmonary edema , unstable angina pectoris, aortic dissection aneurysm , etc. Hypertensive acute diseases also include the clinical situation where blood pressure is acutely increased based on the damage to the original organ function, thereby further impairing the function of the organ function. The acute hazard of hypertension is serious, and active antihypertensive treatment is usually required to prevent further damage to the target organ.
Hypertension sub-acute refers to the clinical situation where blood pressure is significantly increased but not accompanied by target organ damage. It also includes the situation where blood pressure is significantly increased in emergency situations and no organ function damage occurs. Usually, hospitalization is not required, but anti-hypertensive drugs should be treated immediately, and whether hypertension causes cardiorenal damage should be dynamically evaluated and monitored and the possible causes of blood pressure increase should be determined.
The common clinical feature of hypertensive emergency and hypertensive subacute is that blood pressure rises sharply in a short period of time. In severe cases, systolic blood pressure can reach up to 210-240mmHg, and diastolic blood pressure can reach up to 120-130mmHg.
When blood pressure is significantly increased, accompanied by clinical manifestations of acute damage to target organs such as headache, dizziness, irritability, nausea and vomiting, palpitations, , urgency and blurred vision, it is considered to be an acute hypertension.
On the contrary, only those with sharp increase in blood pressure are considered for hypertensive subacute. It should be pointed out that distinguishes whether it is accompanied by newly emerging target organ damage. It requires the evaluation of the organ function in combination with medical history, symptoms, signs and corresponding laboratory auxiliary examinations to make a clear diagnosis. Various hypertensive emergencies have the following clinical common symptoms:
Table 1: Clinical symptoms of target organ damage in patients with hypertensive crisis
Professor Li Nanfang mentioned that there are many reasons for hypertensive crisis, such as patients with hypertensive failure to take medication regularly or suddenly stop taking medication, neuropsychiatric factors, sympathetic active drug poisoning, acute glomerulonephritis , renal vascular disease, eclampsia , head tumor, pheochromocytoma , trauma and surgery, etc.
This reminds clinicians to do a good job in patient education and pay attention to the use of drugs in the diagnosis, treatment and management of hypertension, so as to avoid such serious problems in patients as much as possible.
blood pressure rises sharply,
should "actively control" rather than "rapidly reduce"
Speaking of how to manage the hypertension crisis, Professor Li Nanfang mentioned that blood pressure should still be actively controlled, but it is not blindly to quickly reduce blood pressure to normal values. The cause or cause of acute elevation of blood pressure should be removed and the pressure reduction should be reduced after close monitoring is performed.
After the emergency occurs, choose antihypertensive drugs that act quickly and degrade rapidly. Within 1 hour, blood pressure will be reduced by 15% to 25% on the original basis, and then gradually drop to a safe level until normal blood pressure level to reduce more serious consequences or even death.
Commonly used drugs include sodium nitroprus, nicardipine, labelor , uraldier, esmolol and nitroglycerol , etc., and choose to use alone or in combination according to the specific clinical situation. During this process, the key to is to master the speed and dosage of . Usually, the average arterial pressure of is reduced by about 25% on the original basis or the diastolic pressure is lower than 110mmHg, so that the patient's blood pressure is significantly controlled. At the same time, important organs such as the heart, brain, and kidneys do not show ischemic symptoms due to the rapid decline in blood pressure.
After the blood pressure is ideally controlled, the intravenous antihypertensive drugs should be gradually slowed down and reduced. At the same time, oral antihypertensive drugs should be added, and the dosage and speed of intravenous administration should be gradually reduced. Finally, oral antihypertensive drugs should be completely replaced by oral antihypertensive drugs; if oral antihypertensive drugs are not added first and the intravenous administration is suddenly terminated, it is easy to cause blood pressure rebound, and in severe cases, it may be accompanied by the risk of cerebrovascular accidents.
Hypertensive subacutes can be followed by oral antihypertensive drugs to gradually lower blood pressure. Usually, the average arterial pressure is reduced by about 20% within 24 hours, or the diastolic blood pressure is lower than 120mmHg, followed by follow-up treatment, generally no hospitalization is required.
Whether it is an acute or a subacute of hypertension, the initial purpose of antihypertensive treatment is to quickly restore blood pressure to normalize, but in this process, the risk of hypoperfusion of terminal organs caused by antihypertensive blood pressure must be taken into account, especially in elderly patients and patients with cardiovascular and cerebrovascular disease . The antihypertensive treatment of hypertensive crisis should be more cautious and the changes in blood pressure and organ perfusion should be closely observed.
In addition to antihypertensive treatment, other symptomatic supportive treatments are also essential. As for whether to choose oral or intravenous medication, it depends on the level of the patient's blood pressure, whether there is damage to the terminal organs, and the urgency of emergency blood pressure reduction. There is no absolute statement. The ultimate goal of is to enable the patient's blood pressure to gradually and smoothly lower the target blood pressure level.
Once a hypertension crisis occurs,
Remember to guard the three "defense lines" of heart, brain and kidney
Regarding the sharp increase in blood pressure, Professor Li Nanfang believes that what clinicians need to pay the most attention to is whether the patient has acute cerebral edema! At present, the pathogenesis of hypertensive encephalopathy is not clear. It is believed that when blood pressure rises sharply, the cerebral artery will continue and strongly contract, and then passive and compulsory diastolic occurs. The increase in blood pressure exceeds the cerebral artery 's own regulatory domain, and the brain's long-term hypoxia and excessive perfusion will cause cerebral edema .
Hypertensive encephalopathy can cause changes in neurological function, and symptoms include headache, confusion and visual impairment; once it occurs, attention should be paid to exclude hemorrhagic and ischemic stroke and subarachnoid hemorrhage . The key to clinical treatment of hypertensive encephalopathy is to lower blood pressure while ensuring irrigation of cerebral blood flow, reduce cerebral edema, reduce intracranial pressure, and avoid the use of drugs that reduce cerebral blood flow .
Also note is renal function. Hypertensive emergencies may cause or aggravate renal insufficiency/renal failure. At this time, you should pay attention to slowly lowering your blood pressure to the target level after several hours to 24 hours, and choose antihypertensive drugs that do not affect renal function and renal blood flow perfusion. At the same time, you should pay special attention to not using antihypertensive drugs in the absence of blood volume, and also pay attention to whether the patient has oliguria, proteinuria, low specific gravity urine and elevated creatinine levels.
Of course, the impact on heart function cannot be ignored. Severe blood pressure increases significantly in the heart afterload. Coupled with the spasm of coronary artery , it will cause problems and ischemia in the heart's blood supply, thereby inducing cardiac insufficiency, heart failure , etc.
Conclusion
Finally, Professor Li Nanfang also hopes that the series of contents of "China Hypertension Day" can improve the people's awareness and attention to hypertension, be aware of your own blood pressure, manage your blood pressure well, and prevent and prevent the occurrence of critical and severe hypertension.
Li Nanfang Professor
Chief Physician Professor Doctoral Supervisor
Xinjiang Uygur Autonomous Region People's Hospital Deputy Director
Xinjiang Uygur Autonomous Region People's Hospital Hypertension Diagnosis and Treatment Research Center, Director of Internal Medicine Teaching and Research Department
Director of Xinjiang Hypertension Research Institute
Director of Xinjiang Uygur Autonomous Region Key Laboratory "Xinjiang Hypertension Research Laboratory"
China Hypertension Alliance Vice Chairman
Expert member of the European Society of Cardiology
International Society of Hypertension
World Hypertension Alliance member
Deputy Chairman of the Hypertension Professional Committee of the Chinese Medical Association
Chinese Medical Association Hypertension Professional Committee National Secondary and Refractory Hypertension Working Committee
Chinese Medical Association Cardiovascular Disease Branch Member and Deputy Head of the National Hypertension Group
National Physicians Regular Examination Vice Chairman of the Nuclear Hypertension Professional Committee
Vice Chairman of the National Heart and Vascular Professional Committee of the Chinese Female Physicians Association
Vice Chairman of the National Cardiovascular and Cerebrovascular Disease Professional Committee of the Chinese Society of Geriatrics
Deputy Chairman of the National Cardiovascular and Cerebrovascular Disease Professional Committee of the Chinese Society of Geriatrics
Standing Committee of the General Medicine Branch of the Chinese Medical Association
Member of the Cardiovascular Professional Committee of the Chinese Medical Association
Executive Director of the Xinjiang Medical Association
Deputy Chairman of the Hypertension Professional Committee of the Chinese Medical Association
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Deputy Chairman of the Internal Medicine Branch of Xinjiang Medical Association
Deputy Chairman of the Cardiovascular Disease Branch of Xinjiang Medical Association
also serves as the Standing Committee and Editorial Committee of 17 core journals of China or the National
PhD and Master's Supervisor
References:
[1] Emergency Physicians Branch of the Chinese Medical Association. Consensus of Experts in Emergency Hypertension Diagnosis and Treatment of Emergency Hypertension [J]. China Emergency Medicine, 2010(10): 12.
[2] Zhou Xiaoyan. Hypertensive Crisis (Hypertensive) Crisis)[J]. Chinese Journal of Emergency Medicine, 2002, 11(3): 2.
This article was first published: Medical Cardiovascular Channel
Author of this article: Professor Li Nanfang Xianfei
Review expert: Professor Li Nanfang Xinjiang Uygur Autonomous Region People's Hospital
Editor: Peng Jianping Peng Sanmei
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