Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite ...Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.展开更多
Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP)is a common clin...Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP)is a common clinical practice among healthcare providers dealing with these critically-ill patients.Several strategies for SUP have been suggested over the past four decades,with acid suppressive therapies being the most commonly used in the ICU.Whether SUP is effective and safe,or not,remains a topic of controversy.The data is still conflicting,and provision of a simple answer is not feasible at the present time.Recently,a large phase IV,multicenter,randomized clinical trial(SUP-ICU),negated the benefits(and harms)of proton pump inhibitors as SUP.This article reviews some of these controversies.展开更多
文摘Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.
文摘Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP)is a common clinical practice among healthcare providers dealing with these critically-ill patients.Several strategies for SUP have been suggested over the past four decades,with acid suppressive therapies being the most commonly used in the ICU.Whether SUP is effective and safe,or not,remains a topic of controversy.The data is still conflicting,and provision of a simple answer is not feasible at the present time.Recently,a large phase IV,multicenter,randomized clinical trial(SUP-ICU),negated the benefits(and harms)of proton pump inhibitors as SUP.This article reviews some of these controversies.
