Abstract
Accelerated hypertension is among the most misunderstood and mismanaged of “acute” medical problems. Most physicians have an urgent need to rapidly lower an elevated blood pressure without considering the pathophysiological principles involved. It should be appreciated that most patients who present to the hospital with an elevated blood pressure are chronically hypertensive with a rightward shift of the pressure/flow cerebral (and renal) autoregulation curve (Figure 20-1). Furthermore, most patients with severe hypertension (diastolic pressure ≥120 mm Hg) have no acute, end-organ damage. Rapid antihypertensive therapy in this setting may be associated with significant morbidity. There are, however, true hypertensive emergencies in which the rapid (controlled) lowering of blood pressure is indicated.
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Selected References
Cohn JN, Franciosa JA, Francis GS, et al. Effect of short-term infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure: results of a Veterans Administration cooperative study. N Engl J Med. 1982;306:1129–1135.
Gray RX Managing critically ill patients with esmolol. An ultra short-acting beta-adrenergic blocker. Chest. 1988;93:398–403.
Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276:1328–1331.
Izumi Y, Benz AM, Clifford DB, Zorumski CF. Neurotoxic effects of sodium nitroprusside in rat hippocampal slices. Exp Neurol. 1993;121:14–23.
Varon J, Marik PE. The diagnosis and management of hypertensive crises. Chest. 2000;118:214–227.
Pasch T, Schulz V, Hoppenshauser G. Nitroprusside-induced formation of cyanide and its detoxication with thiosulphate during deliberate hypotension. J Cardiovasc Pharmacol. 1983;5:77–85.
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Marik, P.E. (2001). Hypertensive Emergencies. In: Handbook of Evidence-Based Critical Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-86943-3_20
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DOI: https://doi.org/10.1007/978-3-642-86943-3_20
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-78093-9
Online ISBN: 978-3-642-86943-3
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