Журнал клинических случаев

The Current Practice of Hypertensive Crises Treatment and the Underestimated Role of Clinical Pharmacists in Ambo Hospital Medical Ward, Ethiopia

Abstract

Minyahil A Woldu, Jimma L Lenjisa, Gobezie T Tegegne, Derartu G Yadeta and Deressa T Chala

Background: Hypertension is an extremely common clinical problem, affecting approximately 1 billion individuals worldwide. An estimated 1% to 2% of patients with chronic hypertension will at some time develop hypertensive crises (Hypertensive urgency and emergency). Hypertensive urgency and emergency are differentiated by the absence or presence of acute end-organ damage, respectively. The blood pressure of patients with hypertensive emergencies should be reduced rapidly during the treatment. It should not be reduced to the normal value, but by approximately 20-30% of the baseline value. The reason for a stepwise reduction in blood pressure is the fact that patients with chronic hypertension have an altered auto regulation curve.

Case presentation: A 60 year old male patient, who has been a known hypertensive patient admitted due to sudden onset of body weakness, difficulty of speech, diverted lips towards the left side, difficulties in eating, moving, coughing and inability to move right side of his extremities since one day. On P/E the pt. was severely sick looking, and unconscious.

Conclusion: A number of both parenteral and oral antihypertensive drugs can be used in these patients. Treatment of hypertensive crises in patients with hypertensive encephalopathy, intracranial haemorrhage, subarachnoid haemorrhage, and thrombotic stroke has been recommended to be initiated with nicardipine, fenoldopam, nimodipine, flunarizine or labetalol.