Bluthochdruck – Der hypertensive Notfall

Die hypertensive Krise und der hypertensive Notfall sind gekennzeichnet durch eine drohende bzw. manifeste Endorganschädigung (zerebral, kardial, renal etc.) im Rahmen einer akuten Entgleisung des arteriellen Blutdrucks (im Allgemeinen systolisch > 180 mmHg und/oder diastolisch > 120 mmHg). Eine Organmanifestation ist eine Notfallsituation, die eine umgehende therapeutische Intervention erfordert. Die initialen Mittel der Wahl, speziell in der prästationären Versorgung, sind Nitroglyzerin, Nitrendipin, Clonidin und Urapidil. Die weitere Therapie orientiert sich dann an der vorherrschenden klinischen Symptomatik sowie an den Ursachen des Blutdruckanstiegs. Nach der Stabilisierung des Blutdrucks sollte man, sofern nicht bereits geschehen, die Hypertonie abklären.

Hypertensive crisis and hypertensive emergency are characterized by an imminent or apparent organ damage (cerebral, cardial, renal etc.) associated with an acute increase of the arterial blood pressure (usually systolic > 180 mmHg and/or diastolic > 120 mmHg). It represents an emergency which requires immediate therapeutic intervention. Drugs of choice for the initial therapy prior to hospitalization are nitroglycerine, nitrendipine, clonidine and urapidil. Further therapy realigns on the predominant clinical symptoms and signs as well as on the cases and reasons of the elevated arterial pressure. If arterial hypertension is not already clarified, this should be done after stabilization of the blood pressure.

Key words

hypertension - hypertensive emergency - organ damage - immediate therapeutic intervention - drugs

Literatur

• 1 Varon J. Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises.  Am J Emerg Med. 2007;  25 949-959
• 2 Lohmeier K, Distelmaier F, van den Heuvel LP et al.. Fatal hypertensive crisis as presentation of mitochondrial complex I deficiency.  Neuropediatrics. 2007;  38 148-150
• 3 Feinberg SS. Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.  J Clin Psychiatry. 2004;  65 1520-1524
• 4 Chase JL. Clinical use of anti-vascular endothelial growth factor monoclonal antibodies in metastatic colorectal cancer.  Pharmacotherapy. 2008;  28
• 5 Patane S, Marte F, La Rosa FC, La RR. Capsaicin and arterial hypertensive crisis.  Int J Cardiol. 2010;  144
• 6 Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation.  Hypertension. 1996;  27 144-147
• 7 O'Mailia JJ, Sander GE, Giles TD. Nifedipine-associated myocardial ischemia or infarction in the treatment of hypertensive urgencies.  Ann Intern Med. 1987;  107 185-186
• 8 Gomez E Angelats, Bragulat E Baur. Hypertension, hypertensive crisis, and hypertensive emergency: approaches to emergency department care.  Emergencias. 2010;  22 209-219
• 9 Yang HJ, Kim JG, Lim YS et al.. Nicardipine versus nitroprusside infusion as antihypertensive therapy in hypertensive emergencies.  J Int Med Res. 2004;  32 118-123
• 10 Bahadur MM, Aggarwal VD, Mali M, Thamba A. Novel therapeutic option in hypertensive crisis: sildenafil augments nitroprusside-induced hypotension.  Nephrol Dial Transplant. 2005;  20 1254-1256
• 11 Chobanian AV, Bakris GL, Black HR et al.. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.  JAMA. 2003;  289 2560-2572
• 12 Hudson M, Baron M, Lo E et al.. An international, web-based, prospective cohort study to determine whether the use of ACE inhibitors prior to the onset of scleroderma renal crisis is associated with worse outcomes-methodology and preliminary results.  Int J Rheumatol. pii: 347402. Epub 2010; 
• 13 Middeke M. Hypertensive Krise und hypertensiver Notfall. In: Middeke M, Hrsg. Arterielle Hypertonie. Aufl. Stuttgart: Thieme; 2005. 1: 170-175

Korrespondenz