Hypertensive Encephalopathy Treatment & Management

  • Author: Ryan C Chang, MD; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM   more...
 
Updated: Apr 19, 2010
 

Medical Care

In patients without hypertension, cerebral autoregulation preserves a relatively constant cerebral blood flow at a range of mean arterial blood pressures of 60-90 mm Hg. In chronically hypertensive patients, autoregulation is altered and shifted upward to maintain a relatively constant cerebral blood flow at a higher mean arterial blood pressure range.

  • When initiating therapy, the baseline blood pressure must be considered to avoid excessive blood pressure lowering and prevent cerebral ischemia. Lowering the mean arterial pressure by 25% and the diastolic blood pressure to 100-110 mm Hg usually is a safe maneuver because of the pressure autoregulatory cerebral blood flow range.
  • Acute monitoring in an intensive care unit with arterial blood pressure monitoring is required for adequate titration of pharmacologic agents and monitoring of end organ function.
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Contributor Information and Disclosures
Author

Ryan C Chang, MD  Consulting Staff, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, Kaiser Permanente San Francisco

Ryan C Chang, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Irawan Susanto, MD  Director of Pulmonary Consultation and Procedures, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, University of California at Los Angeles School of Medicine

Irawan Susanto, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Oleh Wasyl Hnatiuk, MD  Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences

Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM  Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair, Academic Affairs, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center

Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, European Society of Intensive Care Medicine, Shock Society, and Society of Critical Care Medicine

Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

References

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