How to treat hypertensive encephalopathy

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

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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.

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Written by Li Qiang
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The difference between hypertensive encephalopathy and malignant hypertension

Hypertensive encephalopathy and malignant hypertension are two critical conditions that can occur in patients with hypertension, both triggered by a sudden and drastic increase in blood pressure in a short period. Literally, hypertensive encephalopathy focuses on the severe rise in blood pressure in a short term, causing some damage to the nervous system. The main mechanism is due to the too rapid increase in blood pressure over a short period, exceeding the self-regulation range of cerebral blood vessels. At this time, the pressure in the cerebral vessels increases sharply, causing the components of the blood in the cerebral vessels to spill over into the brain tissue, manifesting some neurological symptoms, mainly severe headache, dizziness, nausea, vomiting, seizures, convulsions, and even herniation of the brain, all due to brain edema and intracranial hypertension. Malignant hypertension covers a broader range than hypertensive encephalopathy. Besides the neurological symptoms mentioned above, it also affects other systems, such as acute proteinuria, renal failure, and acute heart failure, focusing on the impact on multiple systems throughout the body, including the brain. Hypertensive encephalopathy is more focused on the reactions in the brain, so these two conditions have a common pathogenesis but focus on different aspects.

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Written by Zhang Yue Mei
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How should one take medicine for high blood pressure?

Patients with hypertension must use effective medications to keep their blood pressure within the normal range to prevent damage to the cardiovascular and cerebrovascular systems. During medication use, patients should not arbitrarily stop taking their medication or switch to different types. It is necessary to regularly monitor blood pressure and adjust the medication dosage or switch types under the guidance of a doctor as blood pressure fluctuates. Randomly stopping medication and discontinuing antihypertensive drugs can cause blood pressure fluctuations and pose greater risks to the body, especially causing ischemia in the heart and brain.

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Written by Li Liu Sheng
Nephrology
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How is hypertensive nephropathy treated?

Long-term hypertension can lead to abnormal kidney structure and function, also known as hypertensive nephropathy. Once hypertensive nephropathy is diagnosed, comprehensive treatment measures are often adopted, including both pharmacological and non-pharmacological treatments. In terms of non-pharmacological treatment, patients should maintain a low-salt diet in their daily life, focusing on a light diet, with a daily salt intake of about 4 grams. Regarding pharmacological treatment, the main goal is to control the patient's blood pressure and reduce urinary protein. Medications that can be used include angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists. Any of these medications can be chosen and used long-term to control blood pressure, protect kidney function, and reduce urinary protein. (Medications should be used under the guidance of a physician, and self-medication should be avoided.)

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How to lower high blood pressure

Patients with hypertension need to adopt a comprehensive approach to reduce their blood pressure, primarily comprising two aspects: On one hand, they should regulate their lifestyle for treatment purposes, which includes maintaining a long-term low-salt and low-oil diet, consuming more vegetables and fruits, regularly engaging in physical exercises and labor, keeping a healthy weight level, avoiding fatigue, not staying up late at night, and maintaining a good emotional state. On the other hand, suitable antihypertensive medications should be chosen based on the specific conditions of the patients and used long-term. If necessary, a combination of antihypertensive drugs may be required. Effective control of blood pressure can only be achieved by combining lifestyle adjustments with medication.