Hypertensive crisis in family medicine – what, when and how?

Abstract:

Hypertensive crisis (HC) is an emergency condition characterized by systolic blood pressure (BP) >180 mmHg and/or diastolic BP >120 mmHg, which is caused by humoral vasoconstrictors, often with stress, inadequate adherence, or antihypertensive therapy. After checking the correct BP values, it is important to take a detailed medical history and perform a physical examination and ECG. If there are signs and symptoms of damage to the target organs (chest pain, headache, dyspnea, epistaxis, etc.) along with HC, the patient should be referred to the emergency department as soon as possible, while asymptomatic patients can be treated by a family doctor. BP should be lowered to a maximum of 25% of initial values with a combination of ACE inhibitors and calcium channel blockers. An alpha blocker (urapidil), a vasodilator (nitroglycerin), a diuretic (furosemide) and/or an anxiolytic (diazepam) may be given in specific situations. The patient should then be referred for basic laboratory tests (and others as indicated) and ordered for a control examination in seven days.

Key words:
arterial hypertension; emergency; hypertensive crisis; target organ damage