Treatment
Acute cases of hypertensive encephalopathy require urgent treatment, preferably in intensive care units where vital signs and electroencephalographic characteristics can be monitored. The first measure is to lower blood pressure with drugs. Blood pressure reduction is monitored to avoid damage from excessive reduction. Excessively reduced blood pressure may result in cerebral infarction, blindness and cardiac ischemia.
Intravenously injected diazoxide is effective in 80% of the patients with hypertensive encephalopathy. It normalizes blood pressure within 3-5 min, and the effect lasts 6–18 hours. One benefit of diazoxide is that it does not cause drowsiness and thus does not affect the patient’s state of consciousness. Reflex tachycardia caused by this drug is the major disadvantage which limits its use in patients with ischemic heart disease. Furosemide injected simultaneously with diazoxide enhances both the antihypertensive effect and its duration.
Hydralazine is also administered intravenously or intramuscularly to reduce the blood pressure. Its action is similar to that of diazoxide, but less consistent.
Another drug which is used to reduce blood pressure is sodium nitroprusside which is delivered continuously through intravenous infusion.
Nitroglycerine is also used to decrease blood pressure in patients with hypertensive encephalopathy.
Another class of drugs that are used to reduce blood pressure in hypertensive encephalopathy are ganglionic blocking agents: pentolinium and trimethaphan. These agents have rapid effect, and they do not cause drowsiness. However, they may have side effects, such as bowel and bladder atony. These drugs, with the exception of labetalol, are not used if hypertensive encephalopathy is associated with prepartal eclampsia because they may harm the fetus.
Reserpine, methyldopa and clonidine are less applicable to hypertensive emergency because their effect starts slowly (in 2–3 hours after administration) and they affect the patient's consciousness.
Oral antihypertensive drugs are administered after the patient recovers from the most severe symptoms, and intravenous injections are no longer necessary.
In addition to antihypertensive drugs, anticonvulsant drugs, such as phenytoin, may be given to the patient with seizures. However, typically anti-hypertensive medication is sufficient for treatment of neurological symptoms.
Read more about this topic: Hypertensive Encephalopathy
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