HYPERTENSIVE EMERGENCY IN A DIALYSIS PATIENT. (June 2018)

• Record Type: Journal Article
• Authors: Zerva, K.; Papadopoulos, D.; Anastasiadis, G.; Sanidas, E.; Melexopoulou, C.; Boletis, J.; Barbetseas, J.
• Is Part Of: Journal of hypertension. Volume 36(2018)Supplement 1
• Publication Date: 2018-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000539801.25342.37
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: We present o clinical case of a patient in dialysis with a hypertensive emergency crisis, resistant in treatment. Design and method: A 67 year old woman was presented in the emergency department with shortness of breath, vomiting, headache and dizziness. Her clinical examination revealed moderate dyspnea with bilateral rales, disorientation, reduced muscle strength in the left arm and leg and positive Barre sign. Her Systolic Blood Pressure was 240 mmHg and her Diastolic Blood Pressure was 120mmHg. Her medical history included chronic renal failure, in dialysis during the last 6 years, due to diabetic and hypertensive renal disease. A cranial computed tomography was performed with no signs of stroke or hemorrhage. The patient was classified as having a hypertensive emergency and was admitted in the cardiological intensive care unit. She was treated with intravenous glyceryl trinitrate up to the maximum dose of 0, 2 mg/min for more than 30 minutes and intravenous esmolol without adequate control of the blood pressure and any clinical improvement. A combined medical council of nephrologists and cardiologists was held, in which the admission of intravenous nitroprusside of reduced dosage and under strict monitoring was decided. Results: The patient showed a rapid clinical improvement and a fall in her blood pressure up to 170/100 mmHg. She was monitored for 24 hours and was released from the hospital with instruction for a different, more potent, regular medical treatment. Conclusions: Discussion: Hypertensive emergencies are a clinical entity that requires particular alertness when treating dialysis patients. Pathophysiology includes a variety of mechanisms, such as increased vascular resistance, activation of the renin-angiotensin-aldosterone axis and hyperparathyroidism. Addressing hypertensive crises remains a matter of great importance in these patients. Administration of sodium nitroprusside remains a highly effective option, which can be done with careful monitoring of patients with end-stage renal failure.