====== Arterial hypertension treatment ======

===== Latest Pubmed Related Articles =====
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There are anatomical and physiological evidences that the ventrolateral (VL) region of the [[medulla]] plays an important role in [[blood pressure]] regulation and that dysfunction at this level may generate [[hypertension]] (HT). Vascular compression by a [[megadolicho]]-artery from the [[vertebrobasilar]] arterial system at the root entry/exit zone ([[REZ]]) of the [[glossopharyngeal nerve]] (IXth) and [[vagal nerve]](Xth) cranial nerves (CNs) and the adjacent VL aspect of the medulla has been postulated as a causal factor for HT from neurogenic origin. The first attempts at [[microvascular decompression]] (MVD) of the IX-Xth CNs together with the neighbouring VL brainstem was revealed promising.
Established criteria for an indication of MVD as an aetiological treatment of apparent essential HT are still needed
((Sindou M. Is There a Place for [[Microsurgical Vascular Decompression]] of the
Brainstem for Apparent Essential Blood Hypertension? A Review. Adv Tech Stand
Neurosurg. 2015;42:69-76. PubMed PMID: 25411145.)).

===== Hypertension in stroke patients =====

HTN may actually be needed to maintain CBF in the face of elevated ICP, and it usually resolves spontaneously. Therefore treat HTN cautiously and slowly to avoid rapid reduction and overshooting the target. Avoid treating mild HTN. Indications to treat HTN emergently include:

1. acute LV failure (rare)

2. acute [[aortic dissection]] (rare)

3. acute hypertensive renal failure (rare)

4. neurologic complications of HTN

a) hypertensive encephalopathy

b) conversion of a large pale (ischemic) infarct into a hemorrhagic infarct

c) patients with ICH; some HTN is needed to maintain CBF

===== Guidelines =====

In 2017 the American College of Cardiology and American Heart Association (ACC/AHA) were the first to do so
((Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-e248. doi: 10.1016/j.jacc.2017.11.006. Epub 2017 Nov 13. Erratum in: J Am Coll Cardiol. 2018 May 15;71(19):2275-2279. PMID: 29146535.)), 
followed by the European Society of Cardiology and European Society of Hypertension (ESC/ESH) in 2018
((Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339. Erratum in: Eur Heart J. 2019 Feb 1;40(5):475. PMID: 30165516.)), 
and most recently the National Institute for Health and Care Excellence (NICE), who published their ‘Hypertension in Adults’ guideline in August 2019
((National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. NICE Guideline 136. August, 2019. https://www.nice.org.uk/guidance/ng136.))

===== Drugs =====


===== Angiotensin-converting enzyme inhibitor =====
[[Angiotensin-converting enzyme inhibitor]].

===== Angiotensin II receptor blocker =====
[[Angiotensin II receptor blocker]].

===== Beta blocker =====

[[Beta blocker]]

===== Calcium channel blocker =====
[[Calcium channel blocker]].

===== Diuretics =====
[[Diuretics]]
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To treat [[hypertension]] patients with [[COVID-19]] caused [[pneumonia]], anti-hypertensive drugs ([[ACE]]s and [[ARB]]s) may be used according to the relative guidelines. The treatment regimen with these drugs does not need to be altered for the COVID-19 patients
((Wang W, Zhao X, Wei W, Fan W, Gao K, He S, Zhuang X. Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) may be safe for COVID-19 patients. BMC Infect Dis. 2021 Jan 25;21(1):114. doi: 10.1186/s12879-021-05821-5. PMID: 33494713.)).

===== Parenteral agents =====

General [[Neurocritical Care]] [[parenteral]] [[agent]]s for [[hypertension]]:

[[Nicardipine]]

[[Clevidipine]]

[[Nitroglycerin]]

[[Labetalol]]

[[Enalaprilat]]

[[Esmolol]]

[[Fenoldopam]]

[[Propranolol]]