Hypertension: encephalopathy symptoms improved with treatment

Clinical bottom line (level 4)

Patients with severe hypertension and symptoms of hypertensive encephalopathy had an improvement in symptoms within 5 hours of starting antihypertensive medication.

Krogsgaard et al: Acta Medica Scandinavia 1986; 220: 25-31

Expires October 2003

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: 19 acute hospitals, Denmark

64 patients (aged range 27 to 69 years; mean 54, 61% male) with severe hypertension (diastolic blood pressure > 135 mmHg, and symptoms of hypertensive encephalopathy)

Excluded if

>70 years old

manifest hemiparesis

subarachnoid haemorrhage

severe ischaemic heart disease

pulmonary oedema

S-creatinine >500 ľ mol/l

Patients received iv frusemide followed by iv diazoxide, or im dihydralazine if an inadequate response after one hour

Outcomes studied:

The evidence

After five hours of therapy, only minor cerebral symptoms were present. (initial score: mean 3.6; after 5 hours; mean 1.4)
Improvement in symptoms was not significantly related to the size of the fall in blood pressure.

Comments

Cerebral symptoms included headache (70%), dizziness (35%), consciousness disturbances (28%), nausea (27%), paresis (23%), blurred vision (22%), paraesthesia (21%), and vomiting (14%).
No patients had convulsions or a coma.
No patients developed cerebral complications.

Citation

Krogsgaard AR, McNair A, Hilden T, et al: Reversibility of cerebral symptoms in severe hypertension in relation to acute antihypertensive therapy: a Danish multicenter study. Acta Medica Scandinavia 1986; 220: 25-31

Search Terms: ?
Contributor: Chris Ball and Clare Wotton, October 1999
Reviewer:

_{Clinical Question.}

_Patient	_{hypertensive encephalopathy}
_{Intervention or Exposure}	_{anti-hypertensive medication}
_Outcome	_{improvement in symptoms}