Department of Cardiology, Ochsner Heart & Vascular Institute.
Department of Cardiology, Ochsner Clinical School, Queensland University School of Medicine, New Orleans, Los Angeles, USA.
Curr Opin Cardiol. 2023 Jul 1;38(4):311-317. doi: 10.1097/HCO.0000000000001049. Epub 2023 Mar 28.
Hypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.
Novel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130-140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.
HTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.
高血压危象（HTN-C）的发病率呈上升趋势。它具有显著的发病率和死亡率，因此及时识别和治疗至关重要。由于缺乏对照试验，因此了解 HTN-C 领域的最新文献非常有帮助。
已发现新型血清标志物，包括血清心钠肽前体，有助于早期识别严重高血压引起的靶器官损伤。在缺血性脑卒中溶栓后血压的管理方面，较低的目标血压（130-140mmHg）与某些结局改善相关。两项机械取栓术后降低血压的大型试验未能显示结局改善，但观察数据显示低于目前推荐水平的血压获益更多。二氢吡啶类钙通道阻滞剂盐酸马尼地平，因其独特的 HTN-C 适应证而上市，研究发现其与廉价的通用药物尼卡地平相比无差异。硝苯地平控释片在子痫前期的持续降压方面最有效。
HTN-C 仍然是前瞻性随机试验较少的领域，但针对特定临床情况确定较低目标值的研究正在进行中。理想的治疗药物应针对特定靶器官损伤进行个体化治疗。
