After a detailed anamnesis and clinical examination in which we ruled out life-threatening conditions, we gradually lower the blood pressure with the drug that the patient normally takes, in a higher dose or in the maximum allowed dose. We can also use the drugs we apply in hypertensive crises, but we handle them more gradually and cautiously.

We try to regulate the pressure within 24-48 hours while monitoring the patient in the hospital every 12 hours.

Assessment of the patient’s clinical condition is particularly important because a hypertensive crisis requires a different therapeutic approach than a hypertensive emergency. It is necessary to collect information on the duration and severity of hypertension, previous treatment methods, symptoms that point to neurological and cardiac complications and to large blood vessels.

Therapy is parenteral or, in certain indications, sublingual. The initial goal of pharmacotherapy of a hypertensive crisis is to lower blood pressure by 20-25% of the measured value within 30-60 minutes. The goal is not to normalize blood pressure, but to achieve values ​​that improve the patient’s general condition and relieve symptoms such as dizziness, diplopia, paresis, vomiting, breathing difficulties, chest tightness, etc. clinical condition of the patient.

Associated clinical conditions that require rapid lowering of blood pressure are: pulmonary edema, eclampsia, dissecting aortic aneurysm, hypertensive encephalopathy, and acute myocardial infarction. Reduction of blood pressure to values ​​less than 160/100 mmHg is harmful in the mentioned clinical conditions, and it is necessary to use a drug that is easy to manage and allows for adequate titration. The patient is referred for hospitalization in the intensive care unit under medical supervision and intensive monitoring. In prehospital conditions, parenteral urapidil and furosemide and sublingual nitroglycerin are used in prehospital conditions with associated clinical pictures of pulmonary edema.

Urapidil

• a blocker of alpha-adrenergic receptors on the periphery and an antagonist of central serotonin receptors in the medulla oblongata
• it is used in hypertensive crisis intravenously in a dose of 10-25-50 mg
• the hypotensive effect occurs within five minutes
• frequent control of blood pressure is required during administration (every 2 minutes)
• the drug is administered in the supine position of the patient due to possible orthostatic hypotension
• urapidil does not increase intracranial pressure and is used in hypertensive encephalopathy, hemorrhagic and ischemic stroke
• in combination with beta-blockers, it is used in pheochromocytoma and dissecting aortic aneurysm
• it is also used in eclampsia and has a partial effect in renal failure
• after parenteral administration, the patient should be observed for at least 2-3 hours with control of blood pressure and general condition
• side effects can cause nausea, vomiting, headache, palpitations, difficulty breathing and hypotension
• in case of a hypotensive reaction, the patient should be placed in the position for autoinfusion and replenish the fluid, very rarely it is necessary to use catecholamines, adrenaline 0.5-1 mg diluted in physiological solution
• contraindications for the use of urapidil: stenosis of the aortic wall, arteriovenous shunt, serious liver and kidney disease
• If necessary, the drug can be diluted with saline, 5% and 10% glucose.