Feibel J H, Baldwin C A, Joynt R J
Ann Neurol. 1981 Apr;9(4):340-3. doi: 10.1002/ana.410090405.
Seven patients (4 with subarachnoid hemorrhage, 2 with intracerebral hemorrhage, and 1 with massive cerebral infarction) had acute arterial hypertension refractory to control by several antihypertensive drugs (hydralazine, sodium nitroprusside, alpha-methyldopa, and trimethaphan camsylate) used singly or in combination. In each case, catecholamine excretion--measured by urinary norepinephrine plus epinephrine--was markedly elevated, averaging 218 microgram/day. Patients without the acute refractory hypertension had normal or only slightly elevated urinary catecholamine levels (mean, 72 microgram/day). The beta-adrenergic blocking agent propranolol, in doses between 20 and 40 mg every 6 hours, successfully controlled blood pressure, while other agents failed. The intense sympathetic nervous system discharge resulting in acute refractory hypertension may be due to injury to the diencephalon or brainstem (or both) or to diffuse brain dysfunction from increased intracranial pressure or intracranial blood.
7例患者（4例蛛网膜下腔出血、2例脑出血、1例大面积脑梗死）出现急性动脉高血压，单用或联用几种抗高血压药物（肼屈嗪、硝普钠、甲基多巴和樟磺咪芬）均难以控制。在每种情况下，通过测定尿去甲肾上腺素加肾上腺素来衡量的儿茶酚胺排泄量均显著升高，平均为218微克/天。没有急性难治性高血压的患者尿儿茶酚胺水平正常或仅略有升高（平均72微克/天）。β-肾上腺素能阻滞剂普萘洛尔，每6小时服用20至40毫克，成功控制了血压，而其他药物均无效。导致急性难治性高血压的强烈交感神经系统放电可能是由于间脑或脑干（或两者）损伤，或由于颅内压升高或颅内出血引起的弥漫性脑功能障碍。
