HYPERTENSI CRISIS

Dr. LEONARDO DAIRY, SpPD KGEH

 HYPERTENSI CRISIS
merupakan keadaan yg ditandai tekanan darah yang sangat tinggi dengan kemungkinan akan timbulnya atau telah terjadinya kelainan organ target

Hypertensive

Emergencies and

Urgencies
Acute

or severe increases in blood pressure are serious medical concerns; prompt therapy may be lifesaving. Clinically, these situations can be classified either as EMERGENCY HYPERTENSION (HIPERTENSI DARURAT) URGENCY HPERTENSION (HIPERTENSI MENDESAK)

HYPERTENSIVE EMERGENCY
The

term hypertensive emergency is defined as severe hypertension or a sudden increase in blood pressure with evidence of acute injury to target organs (eg, brain, heart, kidney, vasculature, and retina). It implies the need for hospitalization to immediately lower blood pressure with parenteral therapy. Examples include malignant hypertension, hypertensive encephalopathy, aortic dissection, unstable angina, acute myocardial infarction, eclampsia, pulmonary edema, and acute renal failure.

Hypertensive emergency: severely elevated or suddenly increased blood pressure associated with acute injury to target organs. Hospitalization and parenteral therapy to decrease blood pressure immediately are required. Hypertensive encephalopathy: papilledema, headache, somnolence, confusion, stupor, gastrointestinal tract distress, visual loss,focal neurologic deficits, coma, and seizures. Malignant hypertension: a rapidly progressive vaso spastic disorder. Angiotensin II levels are increased. If not reversed, blood vessel walls undergo necrosis.

HYPERTENSIVE URGENCY
The

term hypertensive urgency is defined as severe hypertension without evidence of acute target organ injury but occurring in a setting in which it is important to decrease blood pressure to safer levels over a 24 to 48hour period. Oral therapy in the outpatient setting is often adequate. Examples include severe hypertension in a person with known coronary artery disease, an aneurysm of the aorta (or other site), or a history of congestive heart failure or severe hypertension immediately following major surgery. Accelerated hypertension is a subacute, progressive increase in blood pressure associated with hemorrhages and exudates (but not papilledema) on retinal examination. If left untreated, it may progress to malignant hypertension.

Hypertensive urgency: severe hypertension without acute target organ injury. Treatment is administered orally and hospitalization usually is not required. Accelerated hypertension may progress to malignant hypertension if not treated.

Treatment
Persons

with hypertensive emergencies should be hospitalized in an intensive care unit. An arterial catheter should be inserted to monitor blood pressure continuously. The challenge of treating hypertensive emergencies is to lower blood pressure promptly without compromising the function of vital organs. Blood pressure should be lowered quickly to a diastolic level of approximately 110 mm Hg (reduce mean blood pressure by 20%), followed by careful monitoring for evidence of worsening cerebral, renal, or cardiac function. Blood pressure is then gradually decreased to a diastolic level of 90 to 100 mm Hg. Ischemic pancreatitis and intestinal infarction are potential serious complications.

PHARMACOLOGIC TREATMENT
(PARENTERAL AGENTS)

Nitroprusside sodium Nitroglycerin,intravenous Labetalol Esmolol Nicardipine Fenoldopam Enalaprilat Diazoxide Hydralazinde Trimethapan Diuretics

PHARMACOLOGIC TREATMENT
(ORAL AGENTS)

Clonidine Captopril Nifedifine

As

soon as possible, initiate regular oral treatment and taper intravenous treatment. After blood pressure has been controlled, search for the cause of the hypertensive crisis and consider secondary causes, especially renovascular disease, pheochromocytoma, and primary aldosteronism.

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