Posterior reversible encephalopathy syndrome (PRES) can emerge in the setting of acute, severe hypertension — or abrupt blood-pressure elevations that fall outside the patient's usual range. Prompt identification and targeted blood-pressure management are central to the clinical response.
This protocol addresses PRES arising in the context of acute, severe hypertension. The disorder may also occur with moderate but abrupt blood-pressure elevations that exceed the patient's accustomed baseline, or following exposure to certain drugs and toxic agents.
Management involves ICU admission with close, continuous blood-pressure monitoring and intravenous antihypertensive therapy. The specific agents, titration strategy, and blood-pressure reduction targets are detailed in the full protocol.
DOI: 10.1056/NEJMra2114482
The disorder typically occurs in patients with acute, severe hypertension or moderate but acute elevations in blood pressure that are outside the accustomed range for the patient, or exposure to certain drugs and toxic agents, mostly from chemotherapeutic drugs and immunosuppressive agents.
For patients with a hypertensive emergency, pertinent cardiology-based treatment guidelines recommend ICU admission with continuous blood-pressure management.
Although a specific blood-pressure target has not been established in the treatment of PRES, there is consensus that blood-pressure reduction generally does not have to exceed 25% of systolic pressure within the first hour, followed by cautious normalization of blood pressure over 24 to 48 hours.
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