{"id":10568,"date":"2019-12-07T04:07:09","date_gmt":"2019-12-07T03:07:09","guid":{"rendered":"http:\/\/news-papers.eu\/?p=10568"},"modified":"2019-11-24T10:34:52","modified_gmt":"2019-11-24T09:34:52","slug":"hypertensiver-notfall","status":"publish","type":"post","link":"https:\/\/news-papers.eu\/?p=10568","title":{"rendered":"Hypertensiver Notfall &#8211; Ein Update"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"10572\" data-permalink=\"https:\/\/news-papers.eu\/?attachment_id=10572\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?fit=1920%2C1275&amp;ssl=1\" data-orig-size=\"1920,1275\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"blood-pressure-2310824_1920\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?fit=1024%2C680&amp;ssl=1\" class=\"size-medium wp-image-10572 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?resize=300%2C199\" alt=\"Blutdruck\" width=\"300\" height=\"199\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?resize=300%2C199&amp;ssl=1 300w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?resize=768%2C510&amp;ssl=1 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?resize=1024%2C680&amp;ssl=1 1024w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?resize=750%2C498&amp;ssl=1 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?w=1920&amp;ssl=1 1920w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz:<\/strong><\/p>\n<p style=\"text-align: justify;\">Eine aktuell im <strong>New England Journal of Medicine<\/strong> erschienene \u00dcbersichtsarbeit zur akuten schweren Hypertension stellt auch f\u00fcr alle notfallmedizinisch T\u00e4tigen sehr sch\u00f6n die Therapieziele dar.<\/p>\n<blockquote><p><strong>Peixoto AJ. Acute Severe <\/strong><strong>Hypertension. N Engl J Med 2019; 381:1843-52;<br \/>\nDOI: 10.1056\/NEJMcp1901117 <\/strong><\/p><\/blockquote>\n<p>Zun\u00e4chst einmal ist es wichtig zu unterscheiden, ob eine hypertensive Entgleisung mit oder ohne Endorgansch\u00e4digung vorliegt.<\/p>\n<p><strong>Endorgansch\u00e4den sind:<\/strong><\/p>\n<ul>\n<li>akutes Nierenversagen<\/li>\n<li>akute Aortendissektion<\/li>\n<li>akutes Koronarsyndrom<\/li>\n<li>akute Linksherzdekompensation<\/li>\n<li>Schlaganfall\/intrazerebrale Blutung<\/li>\n<li>posteriores reversibles Enzephalopathiesyndrom (PRESS, Kopfschmerzen mit Sehst\u00f6rungen, ggf. Krampfanfall und Verwirrtheit)<\/li>\n<li>Sehst\u00f6rungen (durch Papillen\u00f6dem oder Einblutungen in Retina)<\/li>\n<li>diffuser mikrovaskul\u00e4rer Schaden (Retinopathie mit Nierensch\u00e4digung oder mikroangiopathische h\u00e4molytischer An\u00e4mie oder Thrombozytopenie)<\/li>\n<\/ul>\n<p>Wenn keine dieser Endorgansch\u00e4digungen vorliegt, handelt es sich <strong><u>nicht<\/u><\/strong> um einen Notfall:<\/p>\n<ul>\n<li style=\"text-align: justify;\">bei symptomfreien Patienten reicht eine Anpassung der oralen Dauermedikation aus mit einer Empfehlung zur Kontrolluntersuchung beim Hausarzt nach 1-7 Tagen<\/li>\n<li style=\"text-align: justify;\">bei unspezifischen Symptomen, die nicht klar f\u00fcr eine Endorgansch\u00e4digung sprechen (z.B. atypischer Brustschmerz, isolierte Kopfschmerzen, M\u00fcdigkeit etc.) muss gekl\u00e4rt werden, ob diese Symptome auf den erh\u00f6hten Blutdruck zur\u00fcckzuf\u00fchren sind. Auch in diesem Fall kann der Patient ambulant belassen werden. Neben der Anpassung der oralen Dauermedikation kann hier ein schnell wirksames orales Antihypertensivum (z.B. Nifedipin) verabreicht werden.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Folgende Tabelle bietet eine \u00dcbersicht \u00fcber die <strong>Blutdruckziele abh\u00e4ngig von der Endorgansch\u00e4digung<\/strong> und den hierf\u00fcr m\u00f6glichen <strong>blutdrucksenkende Medikamenten<\/strong>:<\/p>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"10571\" data-permalink=\"https:\/\/news-papers.eu\/?attachment_id=10571\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?fit=1122%2C1026&amp;ssl=1\" data-orig-size=\"1122,1026\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Bildschirmfoto 2019-11-24 um 10.31.00\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?fit=1024%2C936&amp;ssl=1\" class=\"alignnone wp-image-10571\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?resize=720%2C658\" alt=\"\" width=\"720\" height=\"658\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?resize=300%2C274&amp;ssl=1 300w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?resize=768%2C702&amp;ssl=1 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?resize=1024%2C936&amp;ssl=1 1024w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?resize=750%2C686&amp;ssl=1 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/Bildschirmfoto-2019-11-24-um-10.31.00.png?w=1122&amp;ssl=1 1122w\" sizes=\"auto, (max-width: 720px) 100vw, 720px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz: Eine aktuell im New England Journal of Medicine erschienene \u00dcbersichtsarbeit zur akuten schweren Hypertension stellt auch f\u00fcr alle notfallmedizinisch T\u00e4tigen sehr sch\u00f6n [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":10572,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[1079],"tags":[446],"class_list":["post-10568","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kardiovaskulaerer-notfall","tag-hypertensiver-notfall"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/12\/blood-pressure-2310824_1920.jpg?fit=1920%2C1275&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-2Ks","jetpack-related-posts":[{"id":6632,"url":"https:\/\/news-papers.eu\/?p=6632","url_meta":{"origin":10568,"position":0},"title":"Hypertensiver Notfall &#8211; Teil 2","author":"Michael Bernhard","date":"Januar 13, 2018","format":false,"excerpt":"Nun zu Teil 2 der Serie zum\u00a0hypertensiven Notfall auf Basis der \u00a0exzellente \u00dcbersicht von Prof. B\u00f6nner: B\u00f6nner G. 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