(精选)Case Based Presentation_ Hypertension in the ICU教学课件.pptVIP

CVA’s Ischemic CVA Protective physiologic response to maintain CPP Impaired auto-regulation Some evidence for induced HTN Treat if: Thrombolysis (SBP/DBP 185/110) End organ damage SBP 220, DBP 120 (critical point at which sphincter tone becomes unbearable) CVA’s Hemorrhagic CVA Controversial topic No evidence HTN leads to increased size of ICH, but there is an association Evidence suggests lowering BP rapidly leads to increased mortality Maintain SBP 200, DBP 130 Lowering MAP ~ 15% does not seem to reduce CBP ATACH Antihypertensive Treatment in Acute Cerebral Hemorrhage 60 patients Reduction in BP using Nicardipine 170 – 200, 140-170, 110-140 mm Hg No difference in any outcome measures Neuro deterioration Adverse events INTERACT Intensive BP reduction in acute cerebral hemorrhage 404 patients with ICH Intensive BP Tx SBP ~140 vs 180 Marginal decrease in hematoma growth, but no differences in any clinical outcome Question 4 Please describe the various agents that can be used in hypertensive emergencies. (Marios) Agents used in hypertensive emergencies Optimal characteristics of drugs used in hypertensive emergencies Easily titratable: Fast onset Sort duration of action Minimal reflex activation of counterregulatory systems (sympathetic, RAAS) Devoid of side-effects or drug interactions Lack of tolerance or tachyphylaxis Pharmacodynamic characteristics of antihypertensive drugs Drug Route Dosage Onset Duration Nitroprusside i.v. infusion 0.25-10 mcg/kg/min Immediate 1-2 min Labetalol i.v. bolus i.v. infusion 10-20 mg up to 80 mg every 10 minutes 0.5-2 mg/min 3-5 min 3-6 h Nitroglycerin i.v. infusion 5-300 mcg/min 1-2 min 1-3 min Nicardipine i.v. infusion 5-15 mg/h 5-10 min 15-40 min Fenoldapam i.v. infusion 0.1-1.6 mcg/kg/min 15 min 30-60 min Esmolol i.v. loading i.v. infusion 1 mg/kg for 1 min 150-300 mcg/kg/min 1-2 min 20-30 min Phentolamine i.v. bolus 5-10 mg every 10 min 1-2 min 10-30 min Enalaprilat i.v. bolus 0.625-1.25 every 6h 10-15 min 6-8 h