How to treat hypertensive encephalopathy

Written by Li Qiang
Intensive Care Unit
Updated on March 18, 2025
00:00
00:00

The treatment goal for hypertensive encephalopathy is mainly to rapidly reduce blood pressure to a reasonable range. Typically, intravenous antihypertensive drugs are administered to decrease blood pressure by 20%-25% within the first hour, followed by oral antihypertensives or continued intravenous treatment to further reduce it to a more reasonable level. Hypertensive encephalopathy often accompanies cerebral edema, and patients may experience increased intracranial pressure. At this point, it is necessary to administer dehydrating agents such as mannitol to treat the cerebral edema. If the patient experiences seizures, which can cause an increase in blood pressure or difficulty in reducing blood pressure, sedative anticonvulsant drugs must be administered to control the seizures. If the patient shows signs of heart failure, diuretic treatment should be initiated. Additionally, high concentration oxygen therapy under high pressure should be administered, which can be delivered through nasal cannula. If nasal oxygen therapy is ineffective, non-invasive ventilation or even intubation with invasive ventilation may be used to provide high concentration positive pressure oxygen therapy.

Other Voices

doctor image
home-news-image
Written by Zhang Yue Mei
Cardiology
58sec home-news-image

Symptoms of hypertension

Hypertension is a common and frequently occurring disease clinically. Mild hypertension often has no clinical symptoms and is usually detected during physical examinations when measuring blood pressure reveals an increase. In cases of severe hypertension, individuals with long-term high blood pressure may experience dizziness, a feeling of pressure in the head, and headaches. In serious cases, symptoms can include tinnitus and palpitations, requiring the use of effective antihypertensive medications for management. If patients with hypertension do not use medications to manage their condition, long-term high blood pressure can cause significant harm to the body, leading to cardiovascular and cerebrovascular diseases, hypertension-induced heart disease, and stroke. (Please use medications under the guidance of a doctor.)

doctor image
home-news-image
Written by Li Hai Wen
Cardiology
52sec home-news-image

Is it called hypertension if the diastolic blood pressure is high?

High diastolic pressure, which is an increase in diastolic pressure, is also considered hypertension when the diastolic pressure exceeds 90mmHg. If you have hypertension, it is essential to have a formal medical examination at a hospital, such as blood tests for lipids and glucose to check for diabetes and hyperlipidemia. Blood tests are also done to evaluate liver and kidney functions, to see if there are any kidney diseases causing the increase in blood pressure. Additionally, under the guidance of a doctor, conduct ambulatory blood pressure monitoring to observe the overall situation of blood pressure increase within 24 hours. Based on the results of the blood tests and ambulatory blood pressure monitoring, determine whether antihypertensive medication is needed and which type of medication to use.

doctor image
home-news-image
Written by Tang Li
Cardiology
53sec home-news-image

Hypertensive crisis blood pressure values

At any stage of hypertension development and other disease emergencies, severe life-threatening blood pressure increases can occur, requiring emergency treatment. Hypertensive crises include hypertensive emergencies and hypertensive urgencies. Hypertensive emergencies refer to severe blood pressure increases within a short time—hours or days—with diastolic pressure greater than 130 mmHg and/or systolic pressure greater than 180 mmHg, accompanied by severe dysfunction or irreversible damage to critical organs and tissues such as the heart, brain, kidneys, retina, and major arteries. Hypertensive urgencies may present as increased blood pressure but without obvious target organ damage.

doctor image
home-news-image
Written by Li Qiang
Intensive Care Unit
1min 18sec home-news-image

How to treat hypertensive encephalopathy

The treatment goal for hypertensive encephalopathy is mainly to rapidly reduce blood pressure to a reasonable range. Typically, intravenous antihypertensive drugs are administered to decrease blood pressure by 20%-25% within the first hour, followed by oral antihypertensives or continued intravenous treatment to further reduce it to a more reasonable level. Hypertensive encephalopathy often accompanies cerebral edema, and patients may experience increased intracranial pressure. At this point, it is necessary to administer dehydrating agents such as mannitol to treat the cerebral edema. If the patient experiences seizures, which can cause an increase in blood pressure or difficulty in reducing blood pressure, sedative anticonvulsant drugs must be administered to control the seizures. If the patient shows signs of heart failure, diuretic treatment should be initiated. Additionally, high concentration oxygen therapy under high pressure should be administered, which can be delivered through nasal cannula. If nasal oxygen therapy is ineffective, non-invasive ventilation or even intubation with invasive ventilation may be used to provide high concentration positive pressure oxygen therapy.

doctor image
home-news-image
Written by Zhou Qi
Nephrology
1min 27sec home-news-image

The difference between hypertensive nephropathy and renal hypertension

Hypertensive nephropathy and hypertension due to kidney disease need to be differentiated, as this affects the treatment approach and prognosis assessment differently. Hypertensive nephropathy refers to patients with long-term high blood pressure, which causes arteriosclerosis of small vessels leading to renal pathology. Often, there is also arteriosclerosis in other organs, such as the retinal arteries, which can be confirmed through funduscopic examination. On the other hand, hypertension due to kidney disease occurs when a patient has kidney disease first followed by hypertension, where the causes and types of kidney diseases vary and can frequently lead to hypertension. The difference between the two lies in the sequence of occurrence. Hypertensive nephropathy is characterized by initial high blood pressure and commonly associated with arteriosclerosis in other vessels, which can be preliminarily identified through funduscopic examination. In cases of hypertension due to kidney disease, the patient has other kidney disorders first, followed by hypertension. If a patient's 24-hour urine protein quantification exceeds 2g, it is likely due to kidney disease rather than hypertensive nephropathy. If differentiation remains challenging, kidney biopsy can be performed for further differentiation.