International Medical Journal, Vol. 24., Iss. 1, 2018, P. 16−19.
UNCOMPLICATED HYPERTENSIVE CRISIS MANAGEMENT IN FAMILY PRACTICE
Kharkiv National Medical University, Ukraine
Hypertensive crisis is a sudden significant increase of the blood pressure from a normal or elevated level, accompanied by the appearance or intensification of disorders in the target organs and characterized by deterioration of the cerebral/coronary/renal circulation or functioning of the autonomic nervous system. An uncomplicated hypertensive crisis is characterized by lack of clinical signs of acute or progressive disorders of target organs, however untimely medical aid to the patient can result in complications and death. Such crises are accompanied by appearance or intensification of symptoms from the target organs (intensive headache, pain in the heart, extrasystole) or the autonomic nervous system (vegetative vascular disorders, tremors, frequent urination). To provide an adequate medical aid for patients, the family doctor needs to know the main features of pharmacological correction of uncomplicated hypertensive crises. The main drugs with classes of antihypertensive drugs and time of their action are indicated. The categories of patients with prescribing preferences are listed. Attention is focused on the definition of the concepts of a complicated and uncomplicated hypertensive crisis, while classification criterion for hypertensive crisis is of importance for the tactics of BP reduction. The explanation is given for direct and potential threat to the life of the patient with the concept of rapid (within a few hours) and immediate (within minutes) reduction of blood pressure. Depending on the presence of side effects, absolute and relative contraindications, the list of the preferences for administration of inhibitors of angiotensin converting enzyme, beta−adrenoblockers, calcium antagonists is presented. Beta−adrenoblockers are effective in young patients with tachycardia syndrome and are unfavorable in cardiac blockade. Drugs of central action are preferable in patients with coronary artery disease. Calcium antagonists of short action should not be administered in persons with heart failure taking in account a negative inotropic effect. Sublingual administration of nifidipine increases the risk of cerebral and coronary ischemia. The considered rational, pathogenetically substantiated approaches to the administration of angiotensive drugs can help the family doctor to provide emergency medical aid in correcting uncomplicated hypertensive crisis in patients.
Key words: uncomplicated hypertensive crisis, risk factors, predictors, drug of choice, rational pharmacotherapy.