Title: Hypertensive Emergencies
题目：高血压急症
Author: Michael Winters
作者：Michael Winters
翻译：江利冰 校对：肖锋

高血压急症处理要点
•It is well known that a hypertensive emergency is not defined by an arbitrary blood pressure reading.  Rather, it is characterized by the presence of end-organ dysfunction, often due to a sudden increase in sympathetic activation.
•众所周知，高血压急症并不是通过一次简单的血压读数来定义的。它的特点是要有终末器官的损伤，往往是因为交感神经活性的突然增加。
•When treating patients with a hypertensive emergency, consider the following:
•当治疗高血压急症时，可以考虑以下方案：
◦Many are hypovolemic due to a pressue-induced natriuresis - give them fluids and avoid diuretics.
◦很多患者因为压力导致的利尿作用，往往存在血容量不足，补液同时避免使用利尿剂。
◦BP should be reduced in a controlled manner using short-acting titratable intravenous agents. Rapid reductions in BP can lead to organ hypoperfusion.
◦应该使用短效的、可调的静脉内使用的降压药，并以一种可控的方式进行降压。降压过快会导致器官的灌注不足。
◦Avoid oral, sublingual, and transdermal medications until end-organ dysfunction has resolved.
◦避免经口、舌下含服以及经皮给药，直到终末器官的功能得以恢复。
◦Clevidipine is the newest agent
A third-generation dihydropyridine
Relaxes arteriolar smooth muscle
Rapid onset (2-4 min) and short acting (5-15 min)
Compares favorably with nicardipine in available studies
氯维地平是最新的制剂。
第三代二氢吡啶类钙拮抗剂
舒张小动脉平滑肌
起效快(2-4 min)同时是短效制剂(5-15 min)
已有研究证实优于尼卡地平
References
参考文献
Monnet X, Marik PE. What's new with hypertensive crisis? Intensive Care Med 2015; 41:127-130.