ΥΠΕΡΤΑΣΙΚΗ ΚΡΙΣΗ: Αντιμετωπίζεται ενιαία?

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  • : ?.

    . &

  • : 180/100mmHg : 210/110mmHg

  • (-) (1-2%). , BP ( , , )

  • (-) BP ( , CHF) BP

  • ()EMERGENCIES : , BP ( ), .URGENCIES : BP .

  • 25% EMERGENCIES 25-30% >120mmHg 16% 4.5% 24% + 36.8%, 12% 2% 4.5%

    Zampaglione et al Hypertension 1996; 27:144-47

  • (EMERGENCIES) 1. 2. ( )3. . (+) . RF

  • (EMERGENCIES) II . CHF + 4. .

  • (EMERGENCIES) III5. - (Tyramine + MAOI)Rebound HTN ( , , )6. (LSD, )

  • (EMERGENCIES) IV7. 8. CABG9. .

  • (URGENCIES) I1. 2. 3. (*)4. 5. (*)6. (*) (*) (*)

  • (URGENCIES) II7. 8. Rebound 9. (*) Metoclopramidea-advenergic agonist + nonselective b-b10. (*) (autonomic hyperreflexia).

  • > 120-130 mmHg : , , . : , , , Stupor, , , . : , . : , .

  • DBP > 140 mmHg : , , . : , , , Stupor, , , . : , . : , .

  • ..

  • .. ( ) ,

  • > 220/120 mmHg (-) (-)Urgency : , 6-24 h (+)( ) -IV ( / )

    Emergency

  • < 25% (2min - 2h)160/100 mmHg (2 - 6h) , .BP / 15-30 min

  • : Enalaprilat- Terazosin Doxazosin Prazosin - - Labetalol Labetalol Carvedilol2- Clonidine Clonidine (TTS) Guanfacine PER OS

  • : PER OS Capropril 25 mg po 15-30 min/6-8h . 15-30 min/2-6hClonidine 0.1-0.2mgpo/h 30-60 min/8-16h max : 0.6mgLabetalol 200-400mgpo/2-3h 30`-2h/2-12hPrazosin 1-2 mg po/h 1-2h/8-12hMinoxidil 5-10 mg po 30-60 min/12-16hFurosemide 40-80 mg Nitroglycerin 1.25-2.5 mg

    /

  • : Nitroprusside 0.25-10 g/Kg/min secs/1-2min Labetalol 20-80mg/10-15min 5-10min/3-6h 2-4mg/minEnalaprilat 0.625-1.25mg 15min/4-12hDiazoxide 50-150mg;5min 1-5min/4-12minHydralazine 10-20mg 5-30min/3-9minFurosemide 40-80 mg Nitroglycerin 3-100g/min 1-5min/3-5min

    /

  • : Esmolol 0.5mg/Kg+50-300g/kg/min 1-2`/10-20` Trimethaphan 1-15mg/min 1-10min/3-10minFenoldopam 0.1-1.6g/kg/min 3-40min/60minPhentolamine 5-10mg;5min 1-2min/3-5minUrapidil 12.5-25mg+5-40mg/h 3-5min/4-6hMethyldopa 250-500mg/6h 30-60min/4-6h Nicardipine 5-15mg/h 5-15min/30-40min

    /

  • (EMERGENCIES) I (+) (-) Labetalol Methyldopa Nicardipine Diazoxide Nitroprusside Reserpine Trimethaphan

  • ( ). . ( ). 4 .

  • BP230/120 mmHg >20min i.v 160-170/95-100 mmHg 180-185/105-110 mmHg

  • < 48h BP < 20% DBP > 140mmHg >20 min i.v. Nitroprusside, Labetalol, Fenoldopam, Urapidil, Nimodipine

  • (EMERGENCIES) III (+) (-) Labetalol Methyldopa Trimethaphan Reserpine Nitroprusside Hydralazine Esmolol Diazoxide

  • (EMERGENCIES) II2) (+) (-) Labetalol Enalaprilat Nicardipine Nitroprusside

  • (EMERGENCIES) IV4)CHF (+) (-) Enalaprilat Labetalol Nitroglycerin Esmolol Nitroprusside5) Nitroglycerin Hydralazine Labetalol Diazoxide Enalaprilat Nitroprusside

  • (EMERGENCIES) V6) (+) (-) Trimethaphan Hydralazine (co) Nitroprusside+ Diazoxide (co) Esmolol7) Phentolamine Labetalol

  • (EMERGENCIES) VI8) (+) (-) Labetalol Trimethaphan Nitroglycerin Nicardipine Hydralazine

  • (+) Nitroprusside ( )Labetalol, CCB, Fenoldopam(-) b-blockers RPF, GFR

  • ()- Hydralazine (DBP > 115 mmHg) Labetalol, Urapidil Ca++ ( , )(-) , Trimethaphan, Nitroprusside, AMEA :

  • : : (, , ) (, ,-mDOPA(-)) - (PRA0.65 ng/ml/h) , , .

    R

  • : : (, , ) (, ,-mDOPA(-)) - (PRA0.65 ng/ml/h) , , .

  • , (PRA< 0.65 ng/ml/h) - (PRA~1ng/ml/h, 6-10ng/ml/h)

    V

  • -K,Na,Ca,U,Cr.,PRA/,,/

    (),/a-Blocker /, ,/, , ,CHF ,B-locker(-).

  • : PER OS . 10 min . 30-40 min , .

  • : :) ) ) LVH .

  • SHOULD A MORATORIUM BE PLACED ON SUBLINGUAL NIFEDIPINE CAPSULES GIVEN FOR HTN EMERGENCIES AND PSEUDOEMERGENCIES ?

    Given the seriousness of the reported adverse events and the lack of any clinical documentation attesting to a benefit, the use of Nifedipine caps should be abandoned.

    E.Grossman et.al JAMA 1996 ; 276:1328-31

  • 6 196 88 ( 45%) 220/120 mmHg5 (2.5%) ()

  • =196143 (73%) ( 5-10 mg )82 (42%) ( i.v, i.m, p.o )19 (10%) ( p.o, i.v )18 (9%) ( p.o, )68 (35%) + 6 (3%) + 8 (4%) ,

  • , (?) . , . /