et. 1.hypertensi crisis

7/28/2019 Et. 1.Hypertensi Crisis

1/11

HYPERTENSI CRISIS

Dr. LEONARDO DAIRY, SpPD KGEH


2/11

HYPERTENSI CRISISmerupakan keadaan yg ditandaitekanan darah yang sangat tinggi

dengan kemungkinan akan timbulnya

atau telah terjadinya kelainan organtarget


3/11

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)


4/11

HYPERTENSIVE EMERGENCY

The term hypertensive emergency is defined assevere hypertension or a sudden increase in blood

pressure with evidence of acute injury to target

organs

(eg, brain, heart, kidney, vasculature, and retina). Itimplies 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.


5/11

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 vasospastic disorder.

Angiotensin II levels are increased.

If not reversed, blood vessel walls undergo necrosis.


6/11

HYPERTENSIVE URGENCY

The term hypertensive urgency is defined as severehypertension 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 inblood pressure associated with hemorrhages and exudates (but

not papilledema) on retinal examination.

If left untreated, it may progress to malignant hypertension.


7/11

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.


8/11

Treatment

Persons with hypertensive emergencies should behospitalized in an intensive care unit. An arterial cathetershould be inserted to monitor blood pressurecontinuously.

The challenge of treating hypertensive emergencies is to

lower blood pressure promptly without compromising thefunction of vital organs. Blood pressure should be loweredquickly 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, orcardiac function. Blood pressure is then graduallydecreased to a diastolic level of 90 to 100 mm Hg.Ischemic pancreatitis and intestinal infarction arepotential serious complications.


9/11

PHARMACOLOGIC TREATMENT(PARENTERAL AGENTS)

Nitroprusside sodium Nitroglycerin,intravenous Labetalol Esmolol Nicardipine Fenoldopam Enalaprilat Diazoxide

Hydralazinde Trimethapan Diuretics


10/11

PHARMACOLOGIC TREATMENT(ORAL AGENTS)

Clonidine

Captopril

NifedifineAs soon as possible, initiate regular oral

treatment and taper intravenous treatment.After blood pressure has been controlled,

search for the cause of the hypertensive crisisand consider secondary causes, especiallyrenovascular disease, pheochromocytoma, andprimary aldosteronism.


11/11

THANK YOU

et. 1.hypertensi crisis

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