Zbrinjavanje bolesnika s hipertenzivnom krizom u izvanbolničkim uvjetima

BACKGROUND. Hypertensive urgencies are common conditions treated in out-of-hospital Emergency Medical Service units, whereas treatment of hypertensive emergencies from current guidelines is hospital based. Current guidelines do not cover in detail the management of hypertensive urgencies, let alone their management in out-of-hospital setting. Our main goal was to evaluate adherence to the existing guidelines. ----- PATIENTS AND METHODS. We analyzed data collected by out-of-hospital Emergency Medical Service unit set up in the Community Health Center in the town of Sveti Ivan Zelina, Croatia. During the one-year period, a total of 2911 patients were treated by Emergency Medical Service unit. Arterial hypertension was the primary diagnosis in 177 (6%) patients, of which 143 patients met the inclusion criteria. We further divided patients into two groups, i.e. hypertensive urgency group (blood pressure >180/120 mm Hg) and control group (systolic blood pressure <180 mm Hg). Different combinations of medications were used, including nitrates, antihypertensives, and anxiolytics. ----- RESULTS. The mean systolic blood pressure reduction was 19.5±7.1% in the hypertensive urgency group and 10.1±7% in control group. The biggest drop in systolic blood pressure (21.9±5.2%) was recorded in hypertensive urgency group patients that received the AT + nitrate + benzodiazepine combination (14% of patients). Less patients that received benzodiazepines were referred to the Integrated Hospital Emergency Admission Unit (4% vs. 23%; p=0.013). ----- CONCLUSION. Patients presenting with hypertensive urgency tend to be treated more aggressively, and there is a place for anxiolytic therapy in hypertensive urgency management. Further research is needed to make definite conclusions.Hipertenzivna hitna stanja zbrinjavaju se najčešće u izvanbolničkom okruženju u slučaju hitnosti bez oštećenja ciljnih organa, dok hipertenzivnu hitnoću s oštećenjem ciljnih organa treba zbrinuti u bolničkim uvjetima. Trenutne kao i prethodne smjernice nemaju jasne preporuke o zbrinjavanju bolesnika s hipertenzivnom krizom koja obuhvaća oba navedena pojma. Cilj ovoga istraživanja bio je procijeniti primjenu i pridržavanje postojećih smjernica za liječenje hipertenzivne krize u izvanbolničkim uvjetima. ----- METODE: Analizirali smo podatke bolesnika koji su zbrinuti u izvanbolničkoj medicinskoj hitnoj službi Sv. Ivan Zelina u razdoblju od godine dana. Ukupno je bilo 2911 bolesnika, od toga je hipertenzija kao primarna dijagnoza bila u 177 (6 %) bolesnika, od kojih je 143 imalo uključne kiterije o podatcima primijenjenog liječenja. Bolesnici su podijeljeni u dvije skupine: skupina s hipertenzivnom hitnosti (krvni tlak >180/120 mm Hg) bez oštećenja ciljnih organa i kontrolna skupina (krvni tlak