Department of Emergency Medicine, Division of Critical Care Medicine, Henry Ford Health and Michigan State University Health Sciences, Detroit, MI, USA
Department of Emergency Medicine, Division of Critical Care Medicine, Henry Ford Health and Michigan State University Health Sciences, Detroit, MI, USA.
BMJ. 2024 Jul 26;386:e077205. doi: 10.1136/bmj-2023-077205.
Hypertensive emergencies cause substantial morbidity and mortality, particularly when acute organ injury is present. Careful and effective strategies to reduce blood pressure and diminish the effects of pressure-mediated injury are essential. While the selection of specific antihypertensive medications varies little across different forms of hypertensive emergencies, the intensity of blood pressure reduction to the target pressure differs substantially. Treatment hinges on balancing the positive effects of lowering blood pressure with the potential for negative effects of organ hypoperfusion in patients with altered autoregulatory mechanisms. When patients do not have acute organ injury in addition to severe hypertension, they benefit from a conservative, outpatient approach to blood pressure management. In all cases, long term control of blood pressure is paramount to prevent recurrent hypertensive emergencies and improve overall prognosis. This review discusses the current evidence and guidelines on the evaluation and management of hypertensive emergency.
高血压急症会导致严重的发病率和死亡率，尤其是当存在急性器官损伤时。精心且有效的降压策略以及减少压力介导损伤的策略至关重要。虽然不同类型的高血压急症中具体降压药物的选择差异不大，但目标血压的降压强度有很大差异。治疗取决于平衡降压的积极作用与器官灌注不足的潜在负面影响之间的关系，对于调节机制改变的患者尤其如此。当除严重高血压外患者没有急性器官损伤时，他们受益于保守的门诊血压管理方法。在所有情况下，长期控制血压对于预防高血压急症的复发和改善整体预后至关重要。本综述讨论了高血压急症评估和管理的现有证据和指南。
