Hipertansif Hastaya Yaklaşım
Özet
Hipertansif bir hastada tansiyon yüksekliğinin doğruluğundan emin olduktan sonra hedef organ hasarı olup olmadığı değerlendirilmeli ve hedef organ hasarı varsa hasta hipertansif acil olarak değerlendirilip yoğun bakıma yatırılmalı ve kan basıncı hızlıca ama yakın takip edilerek uygun seviyelere düşürülmelidir. Hedef organ hasarının türüne göre tercih edilecek farmakolojik ajan ve kan basıncının ne kadar sürede ne kadar düşürüleceği değişim gösterir. Burada kastedilen hedef organlar kalp, beyin, böbrekler, göz (retina) ve büyük damarlardır (aort). Hedef organ hasarı olmayan hastalar PO tedavi ile, hipotansiyona neden olmadan, tansiyon düşüşü sağlanıp kısa bir süre (en az 2 saat) takip edildikten sonra acil servisten taburcu edilebilir.
Referanslar
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. doi: 10.1161/HYP.0000000000000066.
Miller J, McNaughton C, Joyce K, et al. Hypertension Management in Emergency Departments. American Journal of Hypertension. 2020;33(10):927-934. doi: 10.1093/ajh/hpaa068.
Kilickap M, Barcin C, Goksuluk H, et al. [Data on prevalence of hypertension and blood pressure in Turkey: Systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors]. Türk Kardiyoloji Derneği Arşivi. 2018;46(7):525-545. doi: 10.5543/tkda.2018.15679
Rossi GP, Rossitto G, Maifredini C, et al. Modern Management of Hypertensive Emergencies. High Blood Pressure & Cardiovascular Prevention. 2022;29(1):33-40. doi: 10.1007/s40292-021-00487-1.
Pinna G, Pascale C, Fornengo P, et al. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS One. 2014;9(4):e93542. doi: 10.1371/journal.pone.0093542
van den Born BH, Lip GYH, Brguljan-Hitij J, et al. ESC Council on hypertension position document on the management of hypertensive emergencies. European Heart Journal - Cardiovascular Pharmacotherapy. 2019;5(1):37-46. doi: 10.1093/ehjcvp/pvy032.
Janke AT, McNaughton CD, Brody AM, et al. Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013. Journal of the American Heart Association. 2016;5:e004511. doi: 10.1161/JAHA.116.004511.
Martin JF, Higashiama E, Garcia E, et al. Hypertensive crisis profile. Prevalence and clinical presentation. Arquivos Brasileiros de Cardiologia. 2004;83(2):131-136. doi: 10.1590/s0066-782x2004001400004.
Kumar N, Simek S, Garg N, et al. Thirty-Day Readmissions After Hospitalization for Hypertensive Emergency. Hypertension. 2019;73(1):60-67. doi: 10.1161/HYPERTENSIONAHA.118.11691.
Zampaglione B, Pascale C, Marchisio M, et al. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27(1):144-7. doi: 10.1161/01.hyp.27.1.144.
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-1252. doi: 10.1161/01.HYP.0000107251.49515.c2.
Johnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiology Clinics. 2012;30(4):533-543. doi: 10.1016/j.ccl.2012.07.011.
Muiesan ML, Salvetti M, Amadoro V, et al. An update on hypertensive emergencies and urgencies. Journal of cardiovascular medicine (Hagerstown, Md.). 2015;16(5):372-382. doi: 10.2459/JCM.0000000000000223.
Adebayo O, Rogers RL. Hypertensive Emergencies in the Emergency Department. Emergency Medicine Clinics of North America. 2015;33(3):539-551. doi: 10.1016/j.emc.2015.04.005.
Lip GY, Beevers M, Beevers DG. Do patients with de novo hypertension differ from patients with previously known hypertension when malignant phase hypertension occurs? American Journal of Hypertension. 2000;13(8):934-939. doi: 10.1016/s0895-7061(99)00283-6.
Saguner AM, Dur S, Perrig M, et al. Risk factors promoting hypertensive crises: evidence from a longitudinal study. American Journal of Hypertension. 2010;23(7):775-780. doi: 10.1038/ajh.2010.71.
Papadopoulos DP, Sanidas EA, Viniou NA, et al. Cardiovascular hypertensive emergencies. Current Hypertension Reports. 2015;17(2):5. doi: 10.1007/s11906-014-0515-z.
Sharma K, Mathews EP, Newton F. CE: Hypertensive Emergencies: A Review. The American Journal of Nursing. 2021;121(10):24-35. doi: 10.1097/01.NAJ.0000794104.21262.86.
Brathwaite L, Reif M. Hypertensive Emergencies: A Review of Common Presentations and Treatment Options. Cardiology Clinics. 2019;37(3):275-286. doi: 10.1016/j.ccl.2019.04.003.
Derhaschnig U, Testori C, Riedmueller E, et al. Hypertensive emergencies are associated with elevated markers of inflammation, coagulation, platelet activation and fibrinolysis. Journal of Human Hypertension. 2013;27(6):368-373. doi: 10.1038/jhh.2012.53.
Makó K, Ureche C, Jeremiás Z. An Updated Review of Hypertensive Emergencies and Urgencies. Journal of Cardiovascular Emergencies. 2018;4(2):73-83. doi: 10.2478/jce-2018-0013
Baumann B. Systemic Hypertension. In: Tintinalli J, Stapczynski J, Ma O, Yealy D, Meckler G, Cline DM, editors. Tintinalli’s Emergency Medicine, A Comprehensive Study Guide. 8th ed: McGraw-Hill; 2016. p. 399–409.
Lane D, Beevers M, Barnes N, et al. Inter-arm differences in blood pressure: when are they clinically significant? Journal of Hypertension. 2002;20(6):1089-1095. doi: 10.1097/00004872-200206000-00019.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115. doi: 10.1161/HYP.0000000000000065.
Amraoui F, van Montfrans GA, van den Born BJ. Value of retinal examination in hypertensive encephalopathy. Journal of Human Hypertension. 2010;24(4):274-279. doi: 10.1038/jhh.2009.82.
Chester EM, Agamanolis DP, Banker BQ, et al. Hypertensive encephalopathy: a clinicopathologic study of 20 cases. Neurology. 1978;28(9 Pt 1):928-939. doi: 10.1212/wnl.28.9.928.
van den Born BJ, Koopmans RP, van Montfrans GA. The renin-angiotensin system in malignant hypertension revisited: plasma renin activity, microangiopathic hemolysis, and renal failure in malignant hypertension. American Journal of Hypertension. 2007;20(8):900-906. doi: 10.1016/j.amjhyper.2007.02.018.
Astarita A, Covella M, Vallelonga F, et al. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. Journal of Hypertension. 2020;38(7):1203-1210. doi: 10.1097/HJH.0000000000002372.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure. 2022;24(1):4-131. doi: 10.1002/ejhf.2333.
Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118(2):176-187. doi: 10.1161/CIRCULATIONAHA.107.723874.
Gross H, Grose N. Emergency Neurological Life Support: Acute Ischemic Stroke. Neurocritical Care. 2017;27(Suppl 1):102-115. doi: 10.1007/s12028-017-0449-9.
Bulwa Z, Gomez CR, Morales-Vidal S, et al. Management of Blood Pressure After Acute Ischemic Stroke. Current Neurology and Neuroscience Reports. 2019;19(6):29. doi: 10.1007/s11910-019-0941-z.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi: 10.1161/STR.0000000000000211.
Gawinecka J, Schonrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Medical Weekly. 2017;147:w14489. doi: 10.4414/smw.2017.14489.
Boulestreau R, van den Born BH, Lip GYH, et al. Malignant Hypertension: Current Perspectives and Challenges. Journal of the American Heart Association. 2022;11(7):e023397. doi: 10.1161/JAHA.121.023397.
Brown MA, Magee LA, Kenny LC, et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension (Dallas, Tex. : 1979). 2018;72(1):24-43. doi: 10.1161/HYPERTENSIONAHA.117.10803.
Lew M, Klonis E. Emergency management of eclampsia and severe pre-eclampsia. Emergency Medicine (Fremantle, W.A.). 2003;15(4):361-368. doi: 10.1046/j.1442-2026.2003.00475.x.
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstetrics and Gynecology. 2013;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88.
Duley L, Henderson-Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy. The Cochrane Database of Systematic Reviews. 2006(3):CD001449. doi: 10.1002/14651858.CD001449.pub2.
Peacock WF, Varon J, Baumann BM, et al. CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department. Critical Care (London, England). 2011;15(3):R157. doi: 10.1186/cc10289.
Hottinger DG, Beebe DS, Kozhimannil T, et al. Sodium nitroprusside in 2014: A clinical concepts review. Journal of Anaesthesiology, Clinical Pharmacology. 2014;30(4):462-471. doi: 10.4103/0970-9185.142799.
Moffett BS, Price JF. Evaluation of sodium nitroprusside toxicity in pediatric cardiac surgical patients. The Annals of Pharmacotherapy. 2008;42(11):1600-1604. doi: 10.1345/aph.1L192.
Buch J. Urapidil, a dual-acting antihypertensive agent: Current usage considerations. Advances in Therapy. 2010;27(7):426-443. doi: 10.1007/s12325-010-0039-0.
Papadopoulos DP, Papademetriou V. Metoprolol succinate combination in the treatment of hypertension. Angiology. 2009;60(5):608-613. doi: 10.1177/0003319708326450.
Referanslar
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. doi: 10.1161/HYP.0000000000000066.
Miller J, McNaughton C, Joyce K, et al. Hypertension Management in Emergency Departments. American Journal of Hypertension. 2020;33(10):927-934. doi: 10.1093/ajh/hpaa068.
Kilickap M, Barcin C, Goksuluk H, et al. [Data on prevalence of hypertension and blood pressure in Turkey: Systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors]. Türk Kardiyoloji Derneği Arşivi. 2018;46(7):525-545. doi: 10.5543/tkda.2018.15679
Rossi GP, Rossitto G, Maifredini C, et al. Modern Management of Hypertensive Emergencies. High Blood Pressure & Cardiovascular Prevention. 2022;29(1):33-40. doi: 10.1007/s40292-021-00487-1.
Pinna G, Pascale C, Fornengo P, et al. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS One. 2014;9(4):e93542. doi: 10.1371/journal.pone.0093542
van den Born BH, Lip GYH, Brguljan-Hitij J, et al. ESC Council on hypertension position document on the management of hypertensive emergencies. European Heart Journal - Cardiovascular Pharmacotherapy. 2019;5(1):37-46. doi: 10.1093/ehjcvp/pvy032.
Janke AT, McNaughton CD, Brody AM, et al. Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013. Journal of the American Heart Association. 2016;5:e004511. doi: 10.1161/JAHA.116.004511.
Martin JF, Higashiama E, Garcia E, et al. Hypertensive crisis profile. Prevalence and clinical presentation. Arquivos Brasileiros de Cardiologia. 2004;83(2):131-136. doi: 10.1590/s0066-782x2004001400004.
Kumar N, Simek S, Garg N, et al. Thirty-Day Readmissions After Hospitalization for Hypertensive Emergency. Hypertension. 2019;73(1):60-67. doi: 10.1161/HYPERTENSIONAHA.118.11691.
Zampaglione B, Pascale C, Marchisio M, et al. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27(1):144-7. doi: 10.1161/01.hyp.27.1.144.
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-1252. doi: 10.1161/01.HYP.0000107251.49515.c2.
Johnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiology Clinics. 2012;30(4):533-543. doi: 10.1016/j.ccl.2012.07.011.
Muiesan ML, Salvetti M, Amadoro V, et al. An update on hypertensive emergencies and urgencies. Journal of cardiovascular medicine (Hagerstown, Md.). 2015;16(5):372-382. doi: 10.2459/JCM.0000000000000223.
Adebayo O, Rogers RL. Hypertensive Emergencies in the Emergency Department. Emergency Medicine Clinics of North America. 2015;33(3):539-551. doi: 10.1016/j.emc.2015.04.005.
Lip GY, Beevers M, Beevers DG. Do patients with de novo hypertension differ from patients with previously known hypertension when malignant phase hypertension occurs? American Journal of Hypertension. 2000;13(8):934-939. doi: 10.1016/s0895-7061(99)00283-6.
Saguner AM, Dur S, Perrig M, et al. Risk factors promoting hypertensive crises: evidence from a longitudinal study. American Journal of Hypertension. 2010;23(7):775-780. doi: 10.1038/ajh.2010.71.
Papadopoulos DP, Sanidas EA, Viniou NA, et al. Cardiovascular hypertensive emergencies. Current Hypertension Reports. 2015;17(2):5. doi: 10.1007/s11906-014-0515-z.
Sharma K, Mathews EP, Newton F. CE: Hypertensive Emergencies: A Review. The American Journal of Nursing. 2021;121(10):24-35. doi: 10.1097/01.NAJ.0000794104.21262.86.
Brathwaite L, Reif M. Hypertensive Emergencies: A Review of Common Presentations and Treatment Options. Cardiology Clinics. 2019;37(3):275-286. doi: 10.1016/j.ccl.2019.04.003.
Derhaschnig U, Testori C, Riedmueller E, et al. Hypertensive emergencies are associated with elevated markers of inflammation, coagulation, platelet activation and fibrinolysis. Journal of Human Hypertension. 2013;27(6):368-373. doi: 10.1038/jhh.2012.53.
Makó K, Ureche C, Jeremiás Z. An Updated Review of Hypertensive Emergencies and Urgencies. Journal of Cardiovascular Emergencies. 2018;4(2):73-83. doi: 10.2478/jce-2018-0013
Baumann B. Systemic Hypertension. In: Tintinalli J, Stapczynski J, Ma O, Yealy D, Meckler G, Cline DM, editors. Tintinalli’s Emergency Medicine, A Comprehensive Study Guide. 8th ed: McGraw-Hill; 2016. p. 399–409.
Lane D, Beevers M, Barnes N, et al. Inter-arm differences in blood pressure: when are they clinically significant? Journal of Hypertension. 2002;20(6):1089-1095. doi: 10.1097/00004872-200206000-00019.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115. doi: 10.1161/HYP.0000000000000065.
Amraoui F, van Montfrans GA, van den Born BJ. Value of retinal examination in hypertensive encephalopathy. Journal of Human Hypertension. 2010;24(4):274-279. doi: 10.1038/jhh.2009.82.
Chester EM, Agamanolis DP, Banker BQ, et al. Hypertensive encephalopathy: a clinicopathologic study of 20 cases. Neurology. 1978;28(9 Pt 1):928-939. doi: 10.1212/wnl.28.9.928.
van den Born BJ, Koopmans RP, van Montfrans GA. The renin-angiotensin system in malignant hypertension revisited: plasma renin activity, microangiopathic hemolysis, and renal failure in malignant hypertension. American Journal of Hypertension. 2007;20(8):900-906. doi: 10.1016/j.amjhyper.2007.02.018.
Astarita A, Covella M, Vallelonga F, et al. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. Journal of Hypertension. 2020;38(7):1203-1210. doi: 10.1097/HJH.0000000000002372.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure. 2022;24(1):4-131. doi: 10.1002/ejhf.2333.
Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118(2):176-187. doi: 10.1161/CIRCULATIONAHA.107.723874.
Gross H, Grose N. Emergency Neurological Life Support: Acute Ischemic Stroke. Neurocritical Care. 2017;27(Suppl 1):102-115. doi: 10.1007/s12028-017-0449-9.
Bulwa Z, Gomez CR, Morales-Vidal S, et al. Management of Blood Pressure After Acute Ischemic Stroke. Current Neurology and Neuroscience Reports. 2019;19(6):29. doi: 10.1007/s11910-019-0941-z.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi: 10.1161/STR.0000000000000211.
Gawinecka J, Schonrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Medical Weekly. 2017;147:w14489. doi: 10.4414/smw.2017.14489.
Boulestreau R, van den Born BH, Lip GYH, et al. Malignant Hypertension: Current Perspectives and Challenges. Journal of the American Heart Association. 2022;11(7):e023397. doi: 10.1161/JAHA.121.023397.
Brown MA, Magee LA, Kenny LC, et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension (Dallas, Tex. : 1979). 2018;72(1):24-43. doi: 10.1161/HYPERTENSIONAHA.117.10803.
Lew M, Klonis E. Emergency management of eclampsia and severe pre-eclampsia. Emergency Medicine (Fremantle, W.A.). 2003;15(4):361-368. doi: 10.1046/j.1442-2026.2003.00475.x.
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstetrics and Gynecology. 2013;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88.
Duley L, Henderson-Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy. The Cochrane Database of Systematic Reviews. 2006(3):CD001449. doi: 10.1002/14651858.CD001449.pub2.
Peacock WF, Varon J, Baumann BM, et al. CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department. Critical Care (London, England). 2011;15(3):R157. doi: 10.1186/cc10289.
Hottinger DG, Beebe DS, Kozhimannil T, et al. Sodium nitroprusside in 2014: A clinical concepts review. Journal of Anaesthesiology, Clinical Pharmacology. 2014;30(4):462-471. doi: 10.4103/0970-9185.142799.
Moffett BS, Price JF. Evaluation of sodium nitroprusside toxicity in pediatric cardiac surgical patients. The Annals of Pharmacotherapy. 2008;42(11):1600-1604. doi: 10.1345/aph.1L192.
Buch J. Urapidil, a dual-acting antihypertensive agent: Current usage considerations. Advances in Therapy. 2010;27(7):426-443. doi: 10.1007/s12325-010-0039-0.
Papadopoulos DP, Papademetriou V. Metoprolol succinate combination in the treatment of hypertension. Angiology. 2009;60(5):608-613. doi: 10.1177/0003319708326450.
