CRISIS

HIPERTENSIVA
RUBEN DE LA VEGA ARANA
R1 CARDIOLOGIA
HNAL
 PRESION ARTERIAL

PA = GC X RVS
GC = VS x FC
DEFINICION:
HIPERTENSION ARTERIAL
EPIDEMIOLOGIA
• Se estima que 1,28 mil millones de adultos de 30 a 79 años en todo el mundo tienen
hipertensión, la mayoría (dos tercios) viven en países de ingresos bajos y medios.
• Se estima que el 46% de los adultos con hipertensión no saben que padecen la afección.
• Menos de la mitad de los adultos (42%) con hipertensión son diagnosticados y tratados.
• Aproximadamente 1 de cada 5 adultos (21%) con hipertensión la tiene bajo control.
• La hipertensión es una de las principales causas de muerte prematura en todo el mundo.
CLASIFICACION GUIA EUROPEA 2018

GUIA ACC/AHA 2017

TRATAMIENTO ANTIHIPERTENSIVO
HIPERTENSION RESISTENTE
HYPERTENSIVE CRISES
Severe elevations in blood pressure that may or may not be associated with target-
organ dysfunction

HYPERTENSIVE URGENCIES
Associated with the presence or impendence of target-organ dysfunction

HYPERTENSIVE EMERGENCIES
Not associated with target-organ dysfunction.
DEFINITIONS
HYPERTENSIVE EMERGENCIES
EPIDEMIOLOGY
Only 1%–3% of patients with Within the hypertensive crises, hypertensive
hypertension will have a emergencies account for only around one-
hypertensive emergency during fourth of presentations
their lifetime

with an in-hospital mortality of

around 2.5%.
Hospitalizations secondary to and 1- and 10-year survival greater
hypertensive emergencies, than 90% and 70%,
mortality remains low,
HYPERTENSIVE
EMERGENCIES
 Acute elevation of
Blood Preassure
PATHOGENESIS
Endogenous
Autoregulatory vasoconstrictors (e.g.,
changes in autocrine / catecholamines)
paracrine system
Endogenous
vasodilators (e.g.,
nitric oxide)

This inappropriate hypoperfus

Mechanical vascular wall vasoconstriction and ion and
stress with subsequent microvascular thrombosis end-organ
endothelial damage and ischemia
vascular permeability
Resulting in activation of
platelets, initiation of the
coagulation cascade, deposition
the leakage of plasma of fibrin, and recruitment of
into the vascular wall inflammatory mediators
CLINICAL PRESENTATIONS
 CLINICAL PRESENTATIONS
MALIGNANT ↑ Severe BP (commonly >200/120) + advanced bilateral
retinopathy (hemorrhages, cotton wool spots, papilledema)
HYPERTENSION

HYPERTENSIVE ↑ Severe BP + lethargy, seizures, cortical blindness and

coma in the absence of other explanations
ENCEPHALOPATHY

HYPERTENSIVE ↑ Severe BP + hemolysis and thrombocytopenia in the

absence of other causes and improvement with BP-
THROMBOTIC lowering therapy
MICROANGIOPATHY
SIGNS AND SYMPTOMS
TREATMENT GOALS FOR
HYPERTENSIVE EMERGENCY
TRATAMIENTO
URGENCIA HIPERTENSIVA
GRACIAS POR SU ATENCION