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Documented goals for blood pressure include a reduction in the mean arterial pressure by less than or equal to 25% within the first 8 hours of emergency. [7] If blood pressure is lowered aggressively, patients are at increased risk of complications including stroke, blindness, or kidney failure. [ 6 ]
In these situations of hypertensive emergency, rapid reduction of the blood pressure is mandated to stop ongoing organ damage. [4] In contrast there is no evidence that blood pressure needs to be lowered rapidly in hypertensive urgencies , where there is no evidence of target organ damage; over-aggressive reduction of blood pressure is not ...
Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21% and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. [1]
For patients with long-standing hypertension, patient education on the importance of consistently taking prescribed medications and keeping blood pressure well-controlled is critical. [2] Additionally, future treatments may focus not only on blood pressure control but also the reduction of local inflammation that can lead to end organ damage. [4]
In medicine, the mean arterial pressure (MAP) is an average calculated blood pressure in an individual during a single cardiac cycle. [1] Although methods of estimating MAP vary, a common calculation is to take one-third of the pulse pressure (the difference between the systolic and diastolic pressures), and add that amount to the diastolic pressure.
The initial aim of treatment in hypertensive crises is to rapidly lower the diastolic pressure to about 100 to 105 mmHg (Incorrect - A decrease to 100mmHg from 180 would be almost a 40% decrease from baseline); this goal should be achieved within two to six hours, with the maximum initial fall in BP not exceeding 25 percent of the presenting value.
A hypertensive urgency is a clinical situation in which blood pressure is very high (e.g., 220/125 mmHg) with minimal or no symptoms, and no signs or symptoms indicating acute organ damage. [1] [2] This contrasts with a hypertensive emergency where severely high blood pressure is accompanied by evidence of progressive organ or system damage. [1]
The lower MAP group was found to need less total IV fluids, used fewer blood products, had lower early mortality (within the first 24 hours - which accounts for a large portion of mortality in trauma patients) and trended towards lower 30-day mortality and less postoperative coagulation, concluding that permissive hypotension is safe. [11]