domingo, 15 de febrero de 2015

Emergencias hipertensivas / Hypertensive Emergencies

Master en Anestesia y Analgesia regional guiada por ecografia
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Emergencias hipertensivas
Hypertensive Emergencies
Tomas Janot
Evidence-based Strategies in Herbal Medicine, Psychiatric Disorders and Emergency Medicine, 2015
Introduction. The severest hypertensive states pose an immediate threat to life. To be able to manage these situations, physicians need well-defined recommendations; however, as with some other emergencies, only few evidence-based strategies have been developed to date. As randomized, placebo-controlled trials are very difficult to design and conduct, most guidelines and recommendations are based just on experience. The recommendations and opinions in the present chapter draw mainly from national, European, and American guidelines for the treatment of hypertension, and on guidelines of professional societies such as the European Stroke Organisation as well as the experience gained in the author´s health-care center.
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Hipertensión aguda. Una revisión sistemática y evaluación de las guías
Acute hypertension: a systematic review and appraisal of guidelines.
Pak KJ, Hu T, Fee C, Wang R, Smith M, Bazzano LA.
Ochsner J. 2014 Winter;14(4):655-63.
Abstract
BACKGROUND: Few clinical practice guidelines provide management recommendations for acute hypertensive episodes except in the context of specific conditions such as pregnancy and stroke. METHODS: We performed a systematic search to identify guidelines addressing acute hypertension and appraised the guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) validated quality assessment tool. Two reviewers independently appraised and one extracted key recommendations. Literature on secondary hypertension, hypertension in pregnancy, preeclampsia/eclampsia, stroke, aortic dissection, and pheochromocytoma was excluded. RESULTS: Three guidelines were identified, sponsored by the American College of Emergency Physicians (ACEP), the National Heart, Lung, and Blood Institute (NHLBI), and the European Society of Hypertension (ESH) in conjunction with the European Society of Cardiology (ESC). AGREE II yielded mean domain (%) and overall assessment scores (1-7) as follows: NHLBI: 73%, 5.5; ACEP: 67%, 5.5; and ESH/ESC: 56%, 4.5. Inhypertensive emergencies, the NHLBI guideline recommends reducing mean arterial pressure by ≤25% for the first hour, and then to 160/100-110 mmHg by 2-6 hours with subsequent gradual normalization in 24-48 hours. The ESH/ESC has similar recommendations. The ACEP does not address guidelines for hypertensive emergency but focuses on whether screening for target organ damage or medical intervention in patients with asymptomatic elevated blood pressure in emergency departments reduces the rate of adverse outcomes, concluding that routine screening does not reduce adverse outcomes, but patients with poor follow-up may benefit from routine screening. CONCLUSION: NHLBI and ESH/ESC guidelines are high quality and provide similar recommendations for management of asymptomatic acute hypertensive episodes and hypertensive emergencies. Additional research is needed to inform clinical practice guidelines for this common condition.
KEYWORDS: Acute disease; arterial pressure; blood pressure; emergency treatment; hypertension-malignant; practice guidelines as topic
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