Professional Documents
Culture Documents
70
SBP > 140 mm Hg 65
60 64
DBP > 90 mm Hg
50 54
40 44
30
20 21
10 4 11
0
age (yrs) 18-29 30-39 40-49 50-59 60-69 70-79 80+
Hypertensive Crisis
Prevalence of Hypertensive crisis
5
Definitions
Hypertensive Crisis
Acute increasing of BP
>180/120 mmHg
Need immediate treatment
Kaplan NM ,Hypertensive Crises in : Clinical hypertension 9 th Ed, Lippincott Williams & Wilkins 2006:609-630
Definition...
Hipertensive Emergencies
Diastolic blood pressure> 120 mmHg accompanied by 1 /> acute
conditions :
1. Acute ischaemia or haemorrhagic stroke
2. Hypertensive encephalopathy
3. Acute aortic dissection
4. Eclampsia
5. Funduscopic KW III or IV
6. Acute renal insufficiency
7. Acute miocardial infarction
8. Acute pulmonary edema
9. Conditions of excess catecholamine
10. Bleeding
Definition...
Hipertensive Urgency
History
Physical examination
Additional examination
HISTORY
SOB
Neurological disorder
Blood test
Urinalysis
ECG
Echocardiography
Chest x-ray
Funduscopic : retinopathy st III, and/ papiledema
(rethinopathy st IV)
Renal function test
Intracerebral examination (CT scan, MRI)
Management
A doctor must perform appropriate triage
action to achieve therapeutic goals both
short and long term in patients with
increased blood pressure
Nifedipine
Nifedipine has been widely used via oral or sublingual
administration in the management of hypertensive
emergencies. This mode of administration has not been
approved by FDA and since JNC VI because it may cause
sudden uncontrolled and severe reductions in blood pressure
may precipitate cerebral, renal, and myocardial ischemia that
have been associated with fatal outcomes
USE OF NICARDIPINE
• Nicardipine :
. Dihydropiridine class of CCB
Ca++ Ca++
Blocking
effect of CCB
Actin-Myosin Interaction
Contraction
Ca++ Ca++
PRIMARY HEMODYNAMIC OF
NICARDIPINE EFFECT
• peripheral vasodilatation
• preserve or enhanced cardiac pump activity
------ improve tissue perfusion
• fall in systemic blood pressure, maintain at desired
level
• in comparison with sodium nitropruside – equally
effective, but no cyanide toxic effect in long term use
• not associated adverse effect on cardiovascular and
renal function
NICARDIPINE
CHARACTERISTIC
1.VASOSELECTIVITY
Nicardipine selectivity 30.000 x in smooth muscle cells
blood vessels compared with myocardium
2. Myocardial depression (-)
3. Negative inotropic (-)
4. Rapid and stable antihypertensive effects, reduce blood
pressure gradually < 25% in 2 hours, minimal effects to
heart rate
5. Increase blood flow in major organ : Renal, coroner,
cerebral
Actions to increase organ blood
flow Pharmacodynamic action
blood flow
Baseline value
40
Mean blood pressure 103 11 mmHg
20 Vertebral artery
183 65 mL/min
blood flow
Renal artery
563 29mL/min
0 blood flow
Mean blood pressure
Coronary artery
121 42 mL/min
change rate
blood flow
-10
-20
(⊿%)
(Shoji Suzuki, et al., The 20th Annual Scientific Meeting of the Japanese Society of Hypertension: 1997)
Tissue selectivity between
Calcium Antagonist
Suppression
Coronary Suppression Suppression
Drug of Cardiac
Vasodilation of SA Node of AV Node
Contractility
Verapamil
++++ ++++ +++++ +++++
(phenylalkylamine)
Diltiazem
+++ ++ +++++ ++++
(benzothiazepin)
Nicardipine
+++++ 0 + 0
(dihydropyridine)
Paul E. Marik.2007
Vidt D. 2001
SUMMARY
Hypertensive Crises is an urgent situation that need rapid
management to prevent organ damage