Hypertensive emergencies treatment

Mariani PJ (1986) Pseudoephedrine-induced hypertensive emergency Treatment with labetalol. American Journal of Emergency Medicine 4 141-142. 

Mariani PJ. Pseudoephedrine-induced hypertensive emergency treatment with labetalol. Am J Emerg Med 1986 4 141-2. 

Hyperglycemia drug-induced Hypertension treatment of Hypertensive emergencies treatment of Hypnotics... 

Nifedipine (Table 3) is a potent vasodilator that selectively dilates resistance vessels and has fewer effects on venous vessels. It does not cause reflex tachycardia during chronic therapy. Nifedipine is one of the first-line choices for black or elderly patients and patients having concomitant angina pectoris, diabetes, or peripheral vascular diseases. Nifedipine, sublingually, is also suitable for the treatment of hypertensive emergencies. Nifedipine does not impair sexual function or worsen blood Hpid profile. The side effects are flushing, headache, and dizziness. 

The funduscopic examination may reveal arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, and retinal hemorrhages, exudates, and infarcts. The presence of papilledema indicates hypertensive emergency requiring rapid treatment. 

Patients with acute stroke should be monitored intensely for the development of neurologic worsening, complications, and adverse effects from treatments. The most common reasons for clinical deterioration in stroke patients are (1) extension of the original lesion in the brain (2) development of cerebral edema and raised intracranial pressure (3) hypertensive emergency (4) infection (e.g., urinary and respiratory tract) (5) venous thromboembolism (6) electrolyte abnormalities and rhythm disturbances and (7) recurrent stroke. The approach to monitoring stroke patients is summarized in Table 13-3. 

Di-receptors (comprising subtypes Di and D5) and D2-receptors (comprising subtypes D2, D3, and D4). The aforementioned actions are mediated mainly by D2 receptors. When given by infusion, dopamine causes dilation of renal and splanchnic arteries. This effect is mediated by Di receptors and is utilized in the treatment of cardiovascular shock and hypertensive emergencies by infusion of dopamine and fenoldopam, respectively. At higher doses, Pi-adrenoceptors and, finally, a-receptors are activated, as evidenced by cardiac stimulation and vasoconstriction, respectively. 

Nowadays a broad spectrum of quite specific blood pressure lowering drugs is available which restricts the use of ganglion blockade. There are only a few situations in which the pharmacological blockade autonomous ganglia is clinically useful hypertensive emergencies, controlled hypotension in neurosurgery and in the treatment of pulmonary edema. 

Sodium nitroprusside (SNP) is both a venous and an arterial vasodilator. An important part of its vasodilator action is caused by the release of nitric oxide (NO), similarly as for the organic nitrates. SNP can only be administered via the intravenous route. It is a rapidly and short acting vasodilator. It has been used in the treatment of hypertensive emergencies and in the management of myocardial ischaemia. In spite of its vasodilator action it hardly influences heart rate, in contrast to hydralazine and minoxidil. The dosage of SNP should not be higher than 3 pg/kg/min within 48 h, in order to avoid the rise of cyanide ions and thiocyanate in the blood. 

This chapter describes four vasodilators in detail. Two of these agents, hydralazine and minoxidil, are effective orally and are used for the chronic treatment of primary hypertension. The other two drugs, diazoxide and sodium nitroprusside, are effective only when administered intravenously. They are generally used in the treatment of hypertensive emergencies or during surgery. 

Diazoxide is administered intravenously for the treatment of hypertensive emergencies, particularly malignant hypertension, hypertensive encephalopathy, and eclampsia. It is effective in 75 to 85% of the patients to whom it is administered and rarely reduces blood pressure below the normotensive range. 

A 50-year-old woman is seen in the emergency department complaining of a severe headache, shortness of breath, and ankle edema. Her vision is blurry and her blood pressure is 200/140 mm Hg. A blood test reveals azotemia and proteinuria. A chest radiograph reveals an enlarged cardiac silhouette. Is this a hypertensive emergency, and if so what pharmacological treatment might be considered ... 

PCP intoxication typically produces miosis, nystagmus, hypertension, tachycardia, salivation, flushing, sweating, ataxia, and CNS stimulation or depression. Overdose of PCP is dangerous, as the user becomes violent and emergency treatment is required. It is necessary to keep the user calm and not leave him alone. Withdrawal symptoms of PCP are tremor, seizures, diarrhea, piloerection, and vocalizations. 

Diazoxide [dye az OX ide] is a direct-acting arteriolar vasodilator. It has vascular effects like those of hydralazine. For patients with coronary insufficiency, diazoxide is administered intravenously with a p-blocker, which diminishes reflex activation of the heart. Diazoxide is useful in the treatment of hypertensive emergencies, hypertensive encephalopathy, and eclampsia. Excessive hypotension is the most serious toxicity. 

Labetalol has both a- and p-receptor blocking actions that are due to different isomers (see under P-adrenoceptor block, below). Its parenteral preparation is valuable in the treatment of hypertension emergencies (see p. 491). 

In the past, the difficulties presented in the administration of drugs in the treatment of hypertensive emergencies were largely overcome with the use of nifedipine administered sublingually. The onset of action was rapid, and the drug was also used sublingually for the treatment of acute attacks of angina pectoris. Presently, two types of formulation of nifedipine are available, both intended primarily for peroral administration. The sustained-release formulation is... 

Intravenous administration of adrenahne for treatment of systemic anaphylactic shock should be undertaken with extreme caution, even in patients without a history of cardiovascular disease. At all times the patient must be monitored and emergency treatment should be available. Even the infiltration of low doses of adrenahne for local hemostasis can be attended by these risks one patient developed ventricular tachycardia and severe hypertension after receiving 3.75 mg locally for this purpose (SEDA-17, 160), and the value of this treatment is in any case today regarded as dubious (SEDA-17, 161). 

Bertel O, Conen LD. Treatment of hypertensive emergencies with the calcium channel blocker nifedipine. Am J Med 1985 79(4A) 31-5. 

Rubio-Guerra AF, Vargas-Ayala G, Lozano-Nuevo JJ, Narvaez-Rivera JL, Rodriguez-Lopez L. Comparison between isosorbide dinitrate aerosol and nifedipine in the treatment of hypertensive emergencies. J Hum Hypertens 1999 13(7) 473-6. 

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