Preston R A, Baltodano N M, Cienki J, Materson B J
Clinical Research Center, Department of Medicine, University of Miami School of Medicine, FL 33136, USA.
J Hum Hypertens. 1999 Apr;13(4):249-55. doi: 10.1038/sj.jhh.1000796.
There is relatively little data available on the management of patients with severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications.
To determine the incidence, clinical features, acute management, and clinical course of severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications presenting for emergency department care in a large public teaching hospital.
Chart survey of consecutive emergency department visits.
Ninety-one of 2898 consecutive visits to a public teaching hospital emergency department were specifically for severe, uncomplicated hypertension.
Of 2898 consecutive medical emergency department visits, there were 142 (4.9%) patient visits specifically for systolic blood pressure (SBP) > or =220 mm Hg or diastolic blood pressure (DBP) > or =120 mm Hg. Ninety-one of the 142 patient visits were for severe hypertension in the absence of acute target organ impact or neuroretinopathy. Eighty-nine patients received acute drug therapy. Twenty-nine patients received two drugs, and 15 received three drugs. Sixty-eight patients (75%) received clonidine, and 15 (16.5%) received short-acting nifedipine despite widely published concerns about the safety of this practice. We found a wide variability of blood pressure response to treatment. The average decline in SBP was 50+/-31 mm Hg and the average decline of DBP was 34+/-20 mm Hg over 4.2+/-2.9 h. Forty-two patients (46%) had the SBP reduced to less than 160 mm Hg, and 46 patients (50%) the DBP to less than 100 mm Hg. Long-term management and follow-up were suboptimal. Of 74 patients discharged from the emergency room, 22 patients (30%) returned because of uncontrolled hypertension within an average of 33+/-28 days, 10 patients with hypertensive complications.
Severe hypertension continues to present an important and common problem. Physicians appear to place a strong emphasis on acute lowering of the blood pressure to near-normal levels. Patients are frequently lost to follow-up and have a very high rate of recurrent emergency department visits and hypertensive complications. This study points to a need for detailed, specific practice guidelines and comprehensive disease management protocols for severe, uncomplicated hypertension.
关于重度单纯性高血压患者以及伴有稳定高血压并发症的重度高血压患者的管理，现有数据相对较少。
确定在一家大型公立教学医院急诊科就诊的重度单纯性高血压以及伴有稳定高血压并发症的重度高血压的发病率、临床特征、急性处理措施及临床病程。
对连续的急诊科就诊病例进行图表调查。
在一家公立教学医院急诊科的2898次连续就诊中，有91次是专门针对重度单纯性高血压的。
在2898次连续的医疗急诊科就诊中，有142例（4.9%）患者就诊是专门针对收缩压（SBP）≥220 mmHg或舒张压（DBP）≥120 mmHg。这142例患者就诊中有91次是因重度高血压且无急性靶器官损害或视网膜病变。89例患者接受了急性药物治疗。29例患者使用了两种药物，15例使用了三种药物。68例患者（75%）接受了可乐定治疗，15例（16.5%）接受了短效硝苯地平治疗，尽管这种做法的安全性已被广泛报道。我们发现血压对治疗的反应差异很大。在4.2±2.9小时内，SBP平均下降50±31 mmHg，DBP平均下降34±20 mmHg。42例患者（46%）的SBP降至160 mmHg以下，46例患者（50%）的DBP降至100 mmHg以下。长期管理和随访情况欠佳。在74例从急诊室出院的患者中，22例患者（30%）因高血压未得到控制在平均33±28天内复诊，其中10例伴有高血压并发症。
重度高血压仍然是一个重要且常见的问题。医生似乎非常强调将血压急性降至接近正常水平。患者经常失去随访，急诊复诊率和高血压并发症发生率非常高。本研究表明，对于重度单纯性高血压，需要详细、具体的实践指南和全面的疾病管理方案。
