HYPERTENSIVE CRISES

HYPERTENSIVE CRISES
Patients with severe hypertension are liable to intercurrent episodes in which the pressure rises temporarily to a very high level, and during this phase cerebral or cardiac symptoms may be prominent: for example, transient hemiplegia or monoplegia, amaurosis, intense headache or epileptiform fits of hypertensive encephalopathy may occur over a period of hours or days, or the patient may develop acute left ventricular failure with life-threatening cardiac asthma. Such attacks must be treated energetically and a number of remedies are available for this purpose. A prompt reduction of pressure can be achieved with pentolinium given intravenously in a dose of 0-5 to i mg. This will produce a fall in pressure which lasts for some six hours. The blood pressure should be taken repeatedly at short intervals during and after the injection so that the dose of pentolinium may be varied in accordance with the response obtained. In general it is sufficient to reduce the diastolic pressure to approximately 100 mm. Hg.; it is unnecessary and unwise to attempt to reduce the pressure to the normal level. Repeated doses of pentolinium by the intravenous or subcutaneous route may be necessary to control the pressure.
The patient meanwhile should be nursed in bed in a quiet room and sedated with barbiturates such as amylobarbitone 0-2 g. (3 gr.) orally or phenobarbitone soluble 0-2 g. (3 gr.) by intramuscular injection. Appropriate specific treatment is simultaneously given for cardiac asthma or any other complication present.