HYPERTENSI CRISISDr. LEONARDO DAIRY, SpPD KGEH

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

Systolic blood pressure >220 mmHg or diastolic pressure > 125 mmHg

Hypertensive Emergencies and Urgencies

Clinically, these situations can be classified either as EMERGENCY HYPERTENSION (HIPERTENSI DARURAT) URGENCY HPERTENSION (HIPERTENSI MENDESAK)

TARGET ORGAN DAMAGE

HYPERTENSIVE EMERGENCYThe 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.Examples include malignant hypertension, hypertensive encephalopathy, aortic dissection, unstable angina, acute myocardial infarction, eclampsia, pulmonary edema, and acute renal failure.

Hypertensive encephalopathy: papilledema, headache, somnolence, confusion, stupor, gastrointestinal tract distress, visual loss,focal neurologic deficits, coma, and seizures. Hypertensiive emergency require substantial reduction of blood pressure within 1 hour to avoid the risk of morbidity or death.It implies the need for hospitalization to immediately lower blood pressure with parenteral therapy.

The initial goal in hypertensive emergencies is to reduce the pressure by no more than 25% MABP ( minutes to 1 or 2 hours) and then toward a level of 160/100 mmHg within 2-6 hours.

HYPERTENSIVE URGENCYThe 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 48 hour period. Treatment is administered orally and hospitalization usually is not required.

PHARMACOLOGIC TREATMENT(PARENTERAL AGENTS)Nitroprusside sodiumNitroglycerin,intravenousLabetalolEsmololNicardipineFenoldopamEnalaprilatDiazoxideHydralazindeTrimethapanDiuretics

PHARMACOLOGIC TREATMENT(ORAL AGENTS)ClonidineCaptoprilNifedifineAs 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.

First-line antihypertensive drugsDiuretics blockers 1blockersACE inhibitorsAngiotensin II antagonistsCa antagonists

Combination Therapies-adrenergic blockers and diureticsACE inhibitors and diureticsAngiotensin II receptor antagonists and diureticsCalcium antagonists and ACE inhibitorsOther combinations

THANK YOU

*NSAIDs are used extensively to control pain and inflammationNSAIDs are among the most widely used drugs in the world; each day, it is estimated that 30 million people worldwide benefit from the anti-inflammatory and analgesic effects of these drugs,1 and some 500 million prescriptions for NSAIDs are written every year. NSAID use is particularly common among elderly patients: it is estimated that 10-20% of the elderly ( 65 years) have a current or recent NSAID prescription.2 Indeed, 35% of all NSAIDs prescribed are to individuals over 60 years of age.3

Furthermore, the use of NSAIDs is growing as these drugs become more readily available as over-the-counter medications, and there is increasing use of low-dose aspirin to prevent thrombotic conditions such as myocardial infarction or stroke. Moreover, the population in many parts of the world is becoming increasingly elderly, with a concomitant increase in the incidence of arthritic diseases and, hence, the need for NSAID therapy.

References1 Singh G, Ramey DR, Morfeld D, Shi H, Hatoum HT, Fries JF. Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med 1996;156:15306.2 Griffin MR. Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med 1998;104 Suppl 3A:23S29S.3 Brooks P. Use and benefits of nonsteroidal anti-inflammatory drugs. Am J Med 1998;104:9S13S.

****