Part 1 book "Kaplan’s clinical hypertension" includes content: Hypertensive crises, renal parenchymal hypertension, renovascular hypertension, primary aldosteronism, pheochromocytoma (with a preface about incidental adrenal masses), hypertension induced by cortisol or deoxycorticosterone, other forms of identifiable hypertension, hypertension with pregnancy and the pill, hypertension in childhood and adolescence. | CCH A PPTTEERR HA 8 Hypertensive Crises lthough only a small spot in the large status reversible by reduction of BP. Encephalopathy is A panorama of hypertension hypertensive crises represent on one hand the most more common in previously normotensive individuals whose pressures rise suddenly such as during pregnancy immediate danger to those afflicted and on the with eclampsia the accelerated-malignant course often other the most dramatic proof of the life-saving appears without encephalopathy in individuals with potential of antihypertensive therapy. Such crises are more chronic hypertension whose pressures progres- now less likely to be the end result of chronic hyper- sively rise. tension but may be seen at any age representing the manifestations of suddenly developing hypertension from such diverse causes as substance abuse immu- nosuppressive drugs and human immunodeficiency ACCELERATED-MALIGNANT virus infection Ewen et al. 2009 . HYPERTENSION Mechanisms When BP reaches some critical level in experimen- DEFINITIONS tal animals at a mean arterial pressure of 150 mm A hypertensive emergency is a situation that requires Hg lesions appear in arterial walls and the syn- immediate reduction in blood pressure BP with drome of accelerated-malignant hypertension begins parenteral agents because of acute or progressing tar- Fig. 8-1 . This may be provoked by one or more get organ damage Table 8-1 . vasoactive factors but the accelerated-malignant A hypertensive urgency is a situation with mark- phase is likely to be a nonspecific consequence of edly elevated BP but without severe symptoms or very high BP Beilin amp Goldby 1977 . Any form of progressive target organ damage wherein the BP hypertension may progress to the accelerated- should be reduced within hours often with oral malignant phase some without activation of the agents. Some of the circumstances listed in Table 8-1 renin-angiotensin system or other known humoral may be urgencies rather than emergencies if of
