Hypertensive Encephalopathy Follow-up
- Author: Ryan C Chang, MD; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM more...
Further Inpatient Care
- Acute inpatient intensive care unit monitoring with arterial blood pressure monitoring is required for adequate titration of pharmacologic agents. Routinely perform neurologic reassessment to monitor signs of deterioration due to inadequate treatment, progression of neurologic insult, overzealous reduction in blood pressure, or alternate etiology of the clinical presentation.
- Quickly and effectively treat severe hypertension to avoid progression to coma and death. If invasive monitoring is not immediately available, initiate alternate therapy with agents that do not require close monitoring until a monitored situation becomes available.
Further Outpatient Care
- Regularly reassess hypertension because it is a chronic problem. Adequate control of hypertension is essential in preventing the progression of target organ disease.
- High blood pressure has been associated with a rapid rate of cognitive decline and an increased risk of cardiac and neurologic events.
- To guide the formulation of an effective treatment plan, document prior hypertensive medication regimes that have failed.
Inpatient & Outpatient Medications
- Discharge patients on antihypertensives that were effective in maintaining an adequate blood pressure range during hospitalization.
Deterrence/Prevention
- Recommend lifestyle modifications, including weight reduction to decrease body mass index (BMI) to less than 27, moderation of alcohol and sodium intake, increasing physical activity, and avoidance of tobacco products.
- Patients should adhere to antihypertensive therapy and schedule reassessment at regular intervals to modify failing regimens.
Complications
- Complications of hypertensive encephalopathy result in neurologic deficits from hemorrhage and strokes, which can progress to death.
- Complications of hypertension include the following
- Coma
- Death
- Stroke
- Nephropathy
- Myocardial ischemia/infarction
- Nephropathy
- Retinopathy
- Peripheral vascular disease
Prognosis
The morbidity and mortality associated with hypertensive encephalopathy are related to the degree of target organ damage. Without treatment, the 6-month mortality rate for hypertensive emergencies is 50%, and the 1-year mortality rate approaches 90%.
Patient Education
- Refer patients to a dietitian to reduce the risk of vascular and hypertensive disease.
- Encourage lifestyle modifications, including smoking cessation, increasing exercise, moderation of alcohol, and avoidance of tobacco.
- Educate patients about medication adherence and compliance and enforce the need for medical compliance. Educate patients regarding the effects of uncontrolled hypertension, including the complications of persistent hypertension. Inform patients about signs of acute target organ damage, including visual changes, persistent headaches, and neurological changes.
Bales A. Hypertensive crisis. How to tell if it's an emergency or an urgency. Postgrad Med. May 1 1999;105(5):119-26, 130. [Medline].
Amraoui F, van Montfrans GA, van den Born BJ. Value of retinal examination in hypertensive encephalopathy. J Hum Hypertens. Oct 29 2009;[Medline].
Aggarwal M. Hypertensive crisis: hypertensive emergencies and urgencies. Cardiol Clin. 2006;24:135-46. [Medline].
Biousse V, Newman NJ, Chang GY. Brainstem involvement in hypertensive encephalopathy: clinical and radiological findings. Neurology. Nov 9 2004;63(9):1759-60; author reply 1759-60. [Medline].
Calhoun DA, Oparil S. Treatment of hypertensive crisis. N Engl J Med. Oct 25 1990;323(17):1177-83. [Medline].
Frohlich E.D. Target organ involvement in hypertension: a realistic promise of prevention and reversal. Med Clin North Am. 2004;88:1-9. [Medline].
Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. Feb 1999;17(2):151-83. [Medline].
Healton EB, Brust JC, Feinfeld DA, Thomson GE. Hypertensive encephalopathy and the neurologic manifestations of malignant hypertension. Neurology. Feb 1982;32(2):127-32. [Medline].
Immink RV, van den Born BJ, van Montfrans GA, Koopmans RP, Karemaker JM, van Lieshout JJ. Impaired cerebral autoregulation in patients with malignant hypertension. Circulation. Oct 12 2004;110(15):2241-5. [Medline].
Lip GY, Beevers M, Beevers DG. Complications and survival of 315 patients with malignant-phase hypertension. J Hypertens. Aug 1995;13(8):915-24. [Medline].
Loyke HF. The three phases of blood pressure in stroke. South Med J. Jun 1990;83(6):660-3. [Medline].
Pancioli AM. Hypertension management in neurologic emergencies. Ann Emerg Med. Mar 2008;51(3 Suppl):S24-7. [Medline].
Schilling S, Hartel C, Gehl HB, Sperner J. MRI findings in acute hypertensive encephalopathy. Eur J Neurol. May 2003;10(3):329-30. [Medline].
Smith TM, Nokes SR. Posterior reversible encephalopathy syndrome: an overview. J Ark Med Soc. Dec 2003;100(6):200-2. [Medline].
Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. Mar 3 1973;1(5852):507-10. [Medline].
Tsou TP, Yen ZS, Fang CC, et al. Hypertensive encephalopathy. J Emerg Med. Jul 2004;27(1):85-6. [Medline].
Tzourio C, Dufouil C, Ducimetiere P, Alperovitch A. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology. Dec 10 1999;53(9):1948-52. [Medline].
Webster J, Petrie JC, Jeffers TA, Lovell HG. Accelerated hypertension--patterns of mortality and clinical factors affecting outcome in treated patients. Q J Med. Aug 1993;86(8):485-93. [Medline].
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