CLINICAL SIGNS:
* sudden rise in blood pressure.
* take and resume the tension after a rest, with a suitable cuff, quiet, lying down for 20 minutes.
– beware:
– False hypertensive crises reactive to any stress such as epistaxis.
– a “white-coat” effect, pain or anguish.
* hypertensive urgency:
– diastolic> 130 mmHg , systolic> 230 mmHg.
– hypertensive encephalopathy:
– intense headaches, visual disturbances, disturbances of vigilance evolving towards confusional syndrome, Babinski +, sometimes coma and seizures.
– digestive disorders: nausea, vomiting.
– look for signs of left ventricular failure (PAD) or ischemic heart disease, eclampsia, stroke.
* hypertensive thrust:
– no sign of visceral pain but risk of aggravation of certain cardiovascular or neurovascular pathologies.
DIFFERENTIAL DIAGNOSIS:
* false hypertension of the elderly subject by incompressibility of the arterial wall by mediacalcosis.
* if hypertensive encephalopathy:
– meningeal hemorrhage.
– stroke.
– intracranial hypertension.
ETIOLOGY:
* essential malignant hypertension.
* abrupt cessation of antihypertensive treatment (Catapressan in particular).
* taking sympathomimetics, alcohol, tricyclics, NSAIDs, toxic (cocaine, crack, …), corticosteroids.
* coarctation of the aorta, stenosis of the renal artery.
* eclampsia.
* during IDM, aortic dissection, acute glomerulonephritis, PAO, stroke: but cause or consequence?
* pheochromocytoma:
– palpitations + sweat attacks + hypertensive attacks + headaches.
– elevation of urine cathecolamines> 300 μg / 24 h.
– do abdominal CT scan, MIBG scintigraphy.
DIAGNOSTIC TESTS:
* if hypertensive pressure:
– no.
* if hypertensive urgency:
– scope, SpO².
– ECG: Left ventricular hypertrophy, repolarization disorders, signs of ischemia.
– urine strips: proteinuria, hematuria.
– fundus: stage II or III (edema + exudates + haemorrhages).
– blood ionogram (hypokalemia?), Serum creatinine, NFS, blood glucose.
TREATMENT:
* to calm the pain and the anxiety.
* if asymptomatic hypertensive pressure:
– no treatment most often.
* if HTA and cerebral pain:
– do not lower blood pressure unless it is very severe.
* if HTA and aortic dissection or eclampsia:
– lower blood pressure to around 120 mmHg.
* in other cases:
– gradually lower the blood pressure (25% of their initial values) because of the risk of cerebral ischemia.
* according to the pathological context and the place of care:
– oral:
– Loxen 20: 2 oral tablets.
– or sublingual Lopril: 25 mg to repeat if necessary, 12.5 mg if elderly person.
– or Trandate: 1 to 2 tablets.
– venous route:
– G5%, oxygen therapy in the mask.
– Lasilix: 2 vials of 20 mg IV if pulmonary edema or renal failure (1-2 mg / kg in children).
– or Lénitral: 1 mg IV slow then 0.5-1 mg / h to the electric syringe if coronary insufficiency, cardiac insufficiency or aortic dissection.
– or Eupressyl: 25 mg IV direct to be renewed optionally 1 or 2 times every 5 minutes then 10-30 mg / h by electric syringe (0.8 mg / kg / h in children) whatever the indication.
– or Loxen: 1-2.5 mg IV direct to be renewed 10 minutes later or infusion of 5 mg in 30 minutes, then 1-4 mg / h in maintenance with the electric syringe (1 to 4 μg / kg / min at the child) regardless of the indication except coronary insufficiency.
– or Trandate: 20 mg IV slow then 0.1 mg / kg / h if eclampsia, if pheochromocytoma, aortic dissection or intoxication.
– if failure:
– Sodium nitroprusside (Nipride) to the electric syringe by the resuscitator.
* hospitalization:
– if brain, heart or kidney lesions or any other visceral repercussions associated.
– if medical treatment fails.
– if child or pregnant woman.
– if patient on anticoagulant.
– if fundamentally at stage III.
