Hypertensive Crisis-A Serious Problem in Medical Practice

Abstract

There has recently been a considerable increase in interest in hypertensive crisis-a life-threatening condition. Recent publications indicate that hypertensive crisis is a problem not only in general medicine but also in ophthalmology. Visual disturbances may be the initial symptoms of severe hypertension and can reflect severe systemic changes. It seems appropriate to conduct further studies on the pathogenesis of vascular hypertensive changes, and particularly any associated inflammatory reactions. It also seems justified to introduce screening for hypertensive changes on the eye fundus photographs in emergency departments.Keywords: Hypertensive crisis; Hypertensive urgency; Hypertensive emergency; Hypertensive choroidopathy; Hypertensive retinopathy Hypertensive CrisisHypertensive crisis is a life-threatening condition in which the diastolic pressure usually exceeds 120 mmHg [1,2]. The condition may occur as a hypertensive emergency with target organ damage (brain, heart, kidneys and eyes) or it may occur without target organ damage (hypertensive urgency) [3,4]. Treatment involves lowering blood pressure with antihypertensive agents [3,4].Arriozola-Rodríguez and others presented a twenty-three-year-old patient with sudden bilateral vision loss and hypertensive retinopathy. The patient was diagnosed with hypertensive crisis (his blood pressure was 220/140 mmHg) secondary to chronic renal disease and underwent renal transplantation from a relative [5]. This case was similar to ours of a twenty-five-year-old patient who presented with sudden bilateral reduction in vision associated with chronic kidney failure [1]. This patient was also qualified for a kidney transplant. Aarriozola-Rodríguez and others emphasized that changes in the retinal vasculature may be similar to those in other organs [5,6]. The vascular changes within the kidneys, heart, and retina may have a similar pathogenesis that involves disturbances in endothelial function leading to circulatory dysfunction and reduction of vascular reactivity [5,7]. In our paper, we cited Kovach who described an eighteen-yearold female treated for renal disease secondary to focal segmental glomerulonephritis who developed sudden bilateral visual loss [8]. Kovach reported that glomerulonephritis may be an autoimmune disease although the fundi showed only hypertensive changes and absence of any inflammatory signs [1,8]. However, it should be underlined that clinicopathologic correlations between tissue findings in various organs, including the eyes and kidneys, have already been well-documented. D'Souza and Short claim that the association between high blood pressure and renal and retinal dysfunction is well recognized [9,10]. Both the glomeruli and retina include tiny nets of capillaries. Izzedine and others state that several factors, such as the epithelial growth factor or integrins, which were observed in mouse ocular and renal organogenesis, may later be proven to be important in the development of human eyes and kidneys [11]. Consequently, the authors ...