Ipek Emrah, Oktay Ahmet Afşin, Krim Selim R
aDepartment of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey bDepartment of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute cOchsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
Curr Opin Cardiol. 2017 Jul;32(4):397-406. doi: 10.1097/HCO.0000000000000398.
Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C.
HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively. Recent retrospective studies have demonstrated that emergency department (ED) referrals from an outpatient clinic or rapid BP-lowering strategies in the ED do not lead to improved outcomes in patients with HTN-U.
HTN-C can be a de-novo manifestation or a complication of essential or secondary HTN. The presence of acute EOD is a major poor prognostic indicator in HTN-C. The main objectives of the management of HTN-C are distinction of HTN-E from HTN-U and appropriate risk stratification, prevention or regression of acute EOD due to severely elevated BP, prevention of recurrence of HTN-C with an effective long-term management plan and avoidance of rapid lowering of BP except in some special circumstances. The majority of patients with asymptomatic HTN-U can be safely managed in the outpatient setting without exposing them to the risks of aggressive BP lowering. However, patients with HTN-E require hospitalization, prompt treatment and close monitoring.
在此，我们回顾高血压急症（HTN-C）的当前概念，重点关注流行病学、病因、病理生理学和预后。我们还提供了一种管理HTN-C的实用方法。
HTN-C的特征是血压（BP）严重且突然升高，伴有即将发生或进行性急性终末器官损害（EOD）。根据是否存在急性EOD，HTN-C可分为高血压急症（HTN-E）和高血压亚急症（HTN-U）。最近的回顾性研究表明，门诊转诊至急诊科（ED）或在ED中采用快速降压策略并不会改善HTN-U患者的预后。
HTN-C可以是原发性或继发性高血压的新发表现或并发症。急性EOD的存在是HTN-C的主要不良预后指标。HTN-C管理的主要目标是区分HTN-E和HTN-U并进行适当的风险分层，预防或逆转因血压严重升高导致的急性EOD，通过有效的长期管理计划预防HTN-C复发，以及除某些特殊情况外避免快速降低血压。大多数无症状的HTN-U患者可以在门诊环境中安全管理，而不会使他们面临积极降压的风险。然而，HTN-E患者需要住院、及时治疗和密切监测。
