Hypertensive crisis

Hipertenzivna kriza je stanje akutnog i produženog povećanja krvnog tlaka na vrlo visoke vrijednosti. Prema smjernicama ESH/ESC za liječenje hipertenzije iz 2013. razlikuju se pojmovi hipertenzivne emergencije (eng. hypertensive emergency), koja predstavlja stanje hitnoće u hipertenziji s oštećenjem ciljnih organa (end-organ damage), te hipertenzivne urgencije (eng. hypertensive urgency), koji predstavlja stanje izrazito povišenog krvnog tlaka bez oštećenja ciljnih organa. Točno određenih vrijednosti krvnog tlaka, kojima bi se definirala hipertenzivna kriza, nema. Također, vrijednosti krvnog tlaka pri kojima dolazi do hipertenzivne emergencije s oštećenjem ciljnih organa, ovise o individualnoj toleranciji visokih vrijednosti krvnog tlaka. Od velike je važnosti točno prepoznati postoji li navedeno oštećenje ciljnih organa, dakle radi li se o hipertenzivnoj emergenciji ili o hipertenzivnoj urgenciji, jer se pristup u zbrinjavanju bolesnika razlikuje između ta dva entiteta te, unutar skupine emergencija, terapija ovisi o organskom sustavu čija je funkcija oštećena. Pacijenti s hipertenzivnom emergencijom, kao težim od dva oblika krize, zbrinjavaju se u jedinicama intenzivnog liječenja uz parenteralnu primjenu antihipertenzivnih lijekova, što kod pacijenata s hipertenzivnom urgencijom nije potrebno. Glavni cilj liječenja je sniziti vrijednosti krvnog tlaka, no uz oprez, postepeno i do određene granice, da ne bi došlo do daljnje hipoperfuzije i time do progresije oštećenja ciljnih organa. U prevenciji razvoja hipertenzivne krize potrebna je adekvatna kontrola hipertenzije kod bolesnika što se postiže promjenom životnih navika te uz pomoć medikamentozne terapije. Ključan je čimbenik suradljivost pacijenta, redovita kontrola i uzimanje antihipertenzivne terapije.In hypertensive crisis there is an acute and prolonged rise in blood pressure to very high values. According to 2013. ESH/ESC guidelines for the management of arterial hypertension, there are two different entities in hypertensive crisis, hypertensive emergency which is associated with impending or progressive end-organ damage, and hypertensive urgency, which is defined as isolated large blood pressure elevation without end-organ damage. There are no exact blood pressure values that would define hypertensive crisis. Also, blood pressure values with which hypertensive emergency, including end-organ damage, would develop, depend on each patients own ability to tolerate high values of blood pressure. It is very important to recognize if there is end-organ damage present, so we can differentiate between hypertensive emergency and urgency because there is a considerable difference in treating these hypertensive crisis entities. Also, treatment of hypertensive emergencies depend on the type of end-organ damage present. Patients with hypertensive emergency should be managed in an intensive care unit with antihypertensive drugs given parenterally, which is not necessary in patients with hypertensive urgency. The main treatment goal is to reduce blood pressure values, but this should be done carefully, gradually and to a certan level, so further hypoperfusion and progression of end-organ damage is avoided. Prevention of hypertensive crisis is done by treating pre existing hypertension which is achieved by lifestyle changes and medication therapy. Patient compliance is the key, including regular check-ups and taking the medications exactly as prescribed

DENERVACIJA BUBREŽNIH ARTERIJA I REZISTENTNA HIPERTENZIJA

Renal sympathetic denervation (RDN) with radiofrequency (RF) is being used to treat resistant hypertension in seven non-responder patients (62±6 years for age, 5F/2M) despite treatment with >4 different antihypertensive drugs in optimal doses. Prior to diagnosing a patient as having resistant hypertension, we document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure and secondary causes. Office blood pressure (BP) measurements at 1, 3, 6, 12 and 18 months follow-up visits were compared to baseline. We used STATISTICA 10, 2011 software (Stat Soft Inc., Tulsa, OK, USA). Values are mean SD and considered statistically significant if P <0.001. At baseline, values were 184±21 and 106±26 mmHg for systolic (SBP) and diastolic (DBP), 6.7±1 for number of antihypertensive drug classes. One, 3, 6, 12 and 18 months after RDN, office SBP values were significantly lower (144±13 mmHg, 140±17, 141±15, 139±12 and 135±11 mmHg; P <0.001), with no significant reduction in DBP values at 1, 3, 6, 12 and 18 months after RDN (81±6, 82±9, 79±9, 78±6, and 76±7 mmHg). The number of antihypertensive drug classes before and 6, 12, 18 months after RDN were evaluated. Six months after RDN the number of antihypertensive drug classes required was 6.5±1, after 12 and 18 months was 5.5±1 and 4.5±1. During RDA no complications occurred (the pain during the procedure was well tolerated) and the renal function remained stabile. Renal sympathetic denervation is being a concomitant treatment of drug-resistant hypertension (rHT). The sustained reduction of SBP was observed after the RDN. Patients have benefit the most from procedure after 6-12 months. Further meta-analysis will evaluate the importance of new devices for less pain treatment of RDN.Denervacija bubrežnih arterija (DBA) radiofrekvencijom jedna je od obećavajućih novih metoda liječenja rezistentne hipertenzije refraktorne (RH) na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina od kojih jedan mora biti diuretik. Nakon isključenja sekundarnih uzroka, neadekvatnog mjerenja tlaka te nesuradljivosti prikazujemo učinak DBA u 7 bolesnika (62±6 years for age, 5F/2M) tijekom razdoblja od 18 mjeseci praćenja. Za statističku analizu korišten je program STATISTICA 10, 2011 softwer (Stat Soft Inc., Tulsa, OK, USA), uz razinu značajnosti P <0,001. Bolesnici su praćeni na redovitim ambulantnim kontrolama 1, 3, 6, 12 i 18 mjeseci nakon DBA uz mjerenje krvnog tlaka i praćenje laboratorijskih parametara. Od početnih izmjerenih vrijednosti tlaka u ambulanti 184±21 za sistolički i 106±26 mm Hg za dijastolički tlak, uz prosječni broj antihipertenzivnih lijekova od 6,7±1 nakon DBA 1, 3, 6, 12 i 18 mjeseci prati se značajno smanjenje sistoličkih vrijednosti tlaka (144±13, 140±17, 141±15, 139±12, 135±11 mm Hg; P <0,001), bez značajnog smanjenja dijastoličkih vrijednosti (81±6, 82±9, 79±9, 78±6, 76±7 mmHg). Nakon 6 mjeseci prosječan broj antihipertenzivnih lijekova ostao je nepromijenjen (važno da se objektivizira učinak DBA) i iznosio je 6.5±1, dok je nakon 12 i 18 mjeseci došlo do smanjenja broja antihipertenzivnih lijekova (5.5±1 i 4.5±1). Tijekom DBA bolest je bila podnošljiva, nije zabilježeno neposrednih ni kasnijih komplikacija DBA, bubrežna funkcija je bila stabilna tijekom praćenja. Dokazana je dugoročna sigurnost DBA i učinkovitost na smanjenje sistoličkog krvnog tlaka u bolesnika s refraktornom RH

DENERVACIJA BUBREŽNIH ARTERIJA I REZISTENTNA HIPERTENZIJA

Renal sympathetic denervation (RDN) with radiofrequency (RF) is being used to treat resistant hypertension in seven non-responder patients (62±6 years for age, 5F/2M) despite treatment with >4 different antihypertensive drugs in optimal doses. Prior to diagnosing a patient as having resistant hypertension, we document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure and secondary causes. Office blood pressure (BP) measurements at 1, 3, 6, 12 and 18 months follow-up visits were compared to baseline. We used STATISTICA 10, 2011 software (Stat Soft Inc., Tulsa, OK, USA). Values are mean SD and considered statistically significant if P <0.001. At baseline, values were 184±21 and 106±26 mmHg for systolic (SBP) and diastolic (DBP), 6.7±1 for number of antihypertensive drug classes. One, 3, 6, 12 and 18 months after RDN, office SBP values were significantly lower (144±13 mmHg, 140±17, 141±15, 139±12 and 135±11 mmHg; P <0.001), with no significant reduction in DBP values at 1, 3, 6, 12 and 18 months after RDN (81±6, 82±9, 79±9, 78±6, and 76±7 mmHg). The number of antihypertensive drug classes before and 6, 12, 18 months after RDN were evaluated. Six months after RDN the number of antihypertensive drug classes required was 6.5±1, after 12 and 18 months was 5.5±1 and 4.5±1. During RDA no complications occurred (the pain during the procedure was well tolerated) and the renal function remained stabile. Renal sympathetic denervation is being a concomitant treatment of drug-resistant hypertension (rHT). The sustained reduction of SBP was observed after the RDN. Patients have benefit the most from procedure after 6-12 months. Further meta-analysis will evaluate the importance of new devices for less pain treatment of RDN.Denervacija bubrežnih arterija (DBA) radiofrekvencijom jedna je od obećavajućih novih metoda liječenja rezistentne hipertenzije refraktorne (RH) na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina od kojih jedan mora biti diuretik. Nakon isključenja sekundarnih uzroka, neadekvatnog mjerenja tlaka te nesuradljivosti prikazujemo učinak DBA u 7 bolesnika (62±6 years for age, 5F/2M) tijekom razdoblja od 18 mjeseci praćenja. Za statističku analizu korišten je program STATISTICA 10, 2011 softwer (Stat Soft Inc., Tulsa, OK, USA), uz razinu značajnosti P <0,001. Bolesnici su praćeni na redovitim ambulantnim kontrolama 1, 3, 6, 12 i 18 mjeseci nakon DBA uz mjerenje krvnog tlaka i praćenje laboratorijskih parametara. Od početnih izmjerenih vrijednosti tlaka u ambulanti 184±21 za sistolički i 106±26 mm Hg za dijastolički tlak, uz prosječni broj antihipertenzivnih lijekova od 6,7±1 nakon DBA 1, 3, 6, 12 i 18 mjeseci prati se značajno smanjenje sistoličkih vrijednosti tlaka (144±13, 140±17, 141±15, 139±12, 135±11 mm Hg; P <0,001), bez značajnog smanjenja dijastoličkih vrijednosti (81±6, 82±9, 79±9, 78±6, 76±7 mmHg). Nakon 6 mjeseci prosječan broj antihipertenzivnih lijekova ostao je nepromijenjen (važno da se objektivizira učinak DBA) i iznosio je 6.5±1, dok je nakon 12 i 18 mjeseci došlo do smanjenja broja antihipertenzivnih lijekova (5.5±1 i 4.5±1). Tijekom DBA bolest je bila podnošljiva, nije zabilježeno neposrednih ni kasnijih komplikacija DBA, bubrežna funkcija je bila stabilna tijekom praćenja. Dokazana je dugoročna sigurnost DBA i učinkovitost na smanjenje sistoličkog krvnog tlaka u bolesnika s refraktornom RH

Trenutno mjesto magnetske rezonance u probiru, dijagnostici i liječenju raka prostate

Prostate cancer is the most common cancer in men. Diagnosis of prostate cancer poses a significant challenge, due to several different key parameters that need to be evaluated, such as age, history of prostate specific antigen (PSA), clinical examination and more recently magnetic resonance imaging (MRI). The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mp-MRI) of the prostate has been identified as a test that could alleviate these diagnostic errors. Before prostate cancer treatment pathological confirmation is mandatory. Prostate biopsy is an invasive procedure with rare but not negligible potential complications. There are several methods of prostate biopsy of which most common are systemic or planar prostate biopsy and cognitive or targeted MRI-guided prostate biopsy. Multiparametric MRI has demonstrated better accuracy and reproducibility in detecting, locating and evaluating prostate cancer and also sparing some men unnecessary biopsies. Recent studies have shown a mpMRI benefit for better procedure planning regarding prostate cancer location, extent of disease and length of the urethra. There are still some challenges ahead, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. According to the latest urological clinical guidelines mpMRI became fundamental tool in management of prostate cancer. The aim of this study is to give a brief insight in use of mpMRI in prostate cancer diagnosis and treatment.Rak prostate najčešći je karcinom u muškaraca. Dijagnoza raka prostate predstavlja značajan izazov zbog nekoliko različitih ključnih parametara koje je potrebno procijeniti, kao što su dob, povijest prostata specifičnog antigena (PSA), klinički pregled i u novije vrijeme multiparametrijski MRI (mp-MRI). Trenutna dijagnostika raka prostate rezultirala je prekomjernom dijagnostikom i liječenjem, kao i poddijagnozom i propuštenom dijagnozom kod mnogih muškaraca. Multiparametrijski MRI prostate identificiran je kao test koji bi mogao ublažiti ove pogreške. Prije liječenja raka prostate obavezna je patološka potvrda. Biopsija prostate je invazivan postupak s rijetkim, ali ne i zanemarivim potencijalnim komplikacijama. Postoji nekoliko metoda biopsije prostate od kojih su najčešće sistemska ili planarna biopsija prostate i kognitivna ili ciljana biopsija prostate vođena MRI-om. Mp-MRI pokazao je bolju točnost i reproducibilnost u otkrivanju, lociranju i procjeni raka prostate, a također je poštedio neke muškarace nepotrebne biopsije. Nedavne studije pokazale su korist mpMRI-e za bolje planiranje zahvata s podacima o lokaciji raka prostate, opsegu bolesti i duljini uretre. Pred nama su još neki izazovi, poput osiguravanja visokokvalitetne izvedbe i izvješćivanja o mpMRI-u te osiguravanja da je ovaj dijagnostički put isplativ. Prema najnovijim urološkim kliničkim smjernicama mpMRI je postao temeljni alat u liječenju raka prostate. Cilj ove studije je dati kratak uvid u upotrebu mpMRI-e u dijagnostici i liječenju raka prostate

Methylation pattern of caveolin-1 in prostate cancer as potential cfDNA biomarker

High prevalence and mortality of prostate cancer (PCa) are well known global health issues. Novel biomarkers for better identifying patients with PCa are the subject of extensive research. Prostate specific antigen (PSA) shows low specificity in screening and diagnostics, leading to unnecessary biopsies and health costs. Eighty patients with PCa and benign prostate hyperplasia (BPH) were included in the study. We analyzed CAV1 gene expression and methylation in tissue. CAV1 cfDNA methylation from blood and seminal plasma was accessed as a potential PCa biomarker. Although methylation in blood plasma did not differ between PCa and BPH patients, methylation in seminal plasma showed better PCa biomarker performances than tPSA (AUC 0.63 vs. AUC 0.52). Discrimination of BPH and Gleason grade group 1 PCa patients from patients with higher Gleason grade groups revealed very good performance as well (AUC 0.72). CAV1 methylation is useful biomarker with potential for further seminal plasma cfDNA research, but its diagnostic accuracy should be improved, as well as general knowledge about cfDNA in seminal plasma

Povijest urologije u bolnici Sestara milosrdnica

The history of Croatian urology clearly shows its affiliation to the medical and civilizational circle of the Western world. The Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urology institution in the Republic of Croatia. The Department was established in 1894, when the new Sestre milosrdnice Hospital was open in Vinogradska cesta in Zagreb. It was then that doctor Dragutin Mašek founded the so-called III Department, which, in addition to treating urology patients, also treated patients with conditions of the ear, nose and throat, eye diseases and dermatologic conditions. Dragutin Mašek had already realized that medicine would soon be divided into fields and had assigned younger doctors joining the III Department to specific fields. As a result, urology was given to Aleksandar Blašković, who founded the first independent department of urology in Croatia in 1926. In 1927, he was appointed Professor of urology at the Zagreb School of Medicine, where he established the first department of urology and was giving lectures and practicals. Under his leadership, the Department of Urology was given the status of a Clinic, a teaching department, the first of its kind in Croatia. Owing to all his activities in the field of urology, the history remembers him as the “father of modern Croatian urology”. Over the course of the following years, department chairs had changed, but luckily for the patients, approach to work had not. Conscientiousness, trust, competence and charity. After all, charity is the idea that the hospital carries even in its name, after the Sisters of Charity who had founded it. In all the decades, the Department of Urology has been following global development paths, objectively legging behind top facilities in the world by only a few years. Overall professional and scientific urology activities culminated in 1998, when the Clinic became the Reference Center of the Ministry of Health of the Republic of Croatia for prostate cancer, and in 2011, when it became the European Board of Urology Certified Center. All that has been achieved could not have been done without wholehearted help and cooperation of the nurses, as well as every other department employee from the beginnings of urology until today. Despite its rich history, the Department does not rest on laurels. Today, it is a modern urology department together with its European role models.Prošlost hrvatske urologije jasno određuje njezinu pripadnost medicinskom i civilizacijskom krugu zapadnoga svijeta. Klinika za urologiju KBC “Sestre milosrdnice” najstarija je urološka ustanova u Republici Hrvatskoj. Osnovana je 1894. kad je otvorena nova Bolnica sestara milosrdnica u Zagrebu u Vinogradskoj ulici. Te je godine dr Dragutin Mašek osnovao tzv. III Odjel na kojem su se operativno zbrinjavali osim uroloških bolesnika, bolesnici sa bolestima uha, grla i nosa, sa očnim i dermatološkim bolestima. Dragutin Mašek već tada je vidio da će se medicina uskoro dijeliti na uža područja, pa je dolaskom mlađih liječnika na III. odjel njima prepuštao određena područja, tako da je urologiju preuzeo Aleksandar Blašković koji 1926. godine osniva prvi samostalni odjel za urologiju u Hrvatskoj. Imenovan je 1927. za profesora urologije na Medicinskom fakultetu u Zagrebu gdje osniva prvu katedru za urologiju i vodi predavanja i vježbe. Pod njegovim vodstvom Odjel za urologiju dobio 1943. godine status Klinike za urologiju, prve u Hrvatskoj. Temeljem svih tih aktivnosti na urološkom području povijest ga pamti kao „oca moderne hrvatske urologije“. U godinama koje slijede čelnici urologije su se mijenjali, a svjetonazor u radu na sreću bolesnika ne. Savjest, povjerenje, stručnost i milosrđe. Uostalom, to je znamen koji bolnica nosi u svom imenu. Svih tih desetljeća Klinika za urologiju je pratila suvremene svjetske pravce razvoja, objektivno kasneći tek nekoliko godina za vrhunskim ustanovama u svijetu. Cjelokupna stručna i znanstvena urološka djelatnost kulminira 1998. godine, kada Klinika postaje Referentni centar za tumore prostate Ministarstva zdravstva Republike Hrvatske i 2011. godine kada je postala Centar obuke Europskog odbora za urologiju (European Board of Urology). Sve postignuto ne bi se moglo ostvariti bez svesrdne pomoći i suradnje medicinskih sestara i drugih djelatnika klinike od prvih početaka urologije do današnjih dana. Unatoč bogatojj prošlosti, Klinika ne živi na uspjesima svojih prethodnika. Danas je ta urologija zajedno s njezinim uzorima europska moderna urologija

20 godina Referentnog centra za tumore prostate Ministarstva zdravstva u Klinici za urologiju KBC Sestre milosrdnice

Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urological institution in the Republic of Croatia and this part of Europe. Today, the Department is a modern tertiary healthcare institution, where the most complex methods of urological practice are performed using modern medical devices and highly sophisticated technology. In 2011, our urology specialist education program was certified by the European Board of Urology (EBU) as the only one of its kind in Croatia. The program was recertified in 2017. The Department runs a program for the early detection of prostate cancer and performs more than 240 radical prostatectomies annually, which is the highest number of such interventions in Croatia. The aim of this study is to present the work and the activities of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center over the last 20 years. The database of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center was reviewed. During the twenty-year period, approx-imately 15,000 prostate interventions were performed due to benign and malignant diseases. Of this, 7,374 transrectal ultrasound guided prostate biopsies, 2,632 radical prostatectomies with open retropubic access, 3,988 transurethral prostate resections and 1,097 open suprapubic adenomectomies were performed. With the achieved scientific and professional results in monitoring, studying and improving the prevention, diagnosis and therapy of prostate tumors, as well as with the professional conditions and personnel, the Department of Urology in Sestre milosrdnice University Hospital Center truly justifies the title of the Reference Center for Prostate Tumors of the Ministry of Health of the Republic of Croatia awarded to it in 1998Klinika za urologiju Kliničkog bolničkog centra Sestre milosrdnice najstarija je urološka ustanova u Republici Hrvatskoj, a i u ovom dijelu Europe. Danas je Klinika za urologiju moderna medicinska ustanova tercijarne zdravstvene zaštite gdje se najsloženije metode urološke prakse izvode pomoću suvremenih medicinskih uređaja i visoko sofisticirane tehnologije. Program edukacije specijalizanata je 2011. godine certificiran od strane European Board of Urology (EBU) kao jedini takav u Hrvatskoj, a recertificiran je 2017. godine. U našoj se Klinici provodi program ranog otkrivanja raka prostate, a godišnje se obavlja preko 240 radikalnih prostatektomija što je ujedno i najveći broj takvih zahvata u Hrvatskoj. Cilj rada je prikazati rad i aktivnost Referentnog centra Ministarstva zdravstva za tumore prostate u Klinici za urologiju KBC „Sestre milosrdnice“ u posljednjih 20 godina. Učinjen je pregled baze podataka Referentnog centra za tumore prostate Ministarstva zdravstva u Klinici za urologiju KBC „Sestre milosrdnice“. Tijekom dvadesetogodišnjeg razdoblja učinjeno je oko 15 000 zahvata na prostati zbog benignih i malignih bolesti. Od toga je učinjena 7 374 biopsija prostate vođene transrektalnim ultrazvukom, 2 632 radikalnih prostatekomija otvorenim retropubičnim pristupom, 3 988 transuretralnih resekcija prostate i 1 097 otvorenih suprapubičnih adenomektomija. Postignutim znanstvenim i stručnim rezultatima u praćenju, proučavanju i unaprjeđenju prevencije, dijagnostike i terapije tumora prostate kao i stručno-kadrovskim uvjetima, Klinika za urologiju KBC Sestre milosrdnice opravdava naslov Referentnog centra za tumore prostate Ministarstva zdravstva Republike Hrvatske koji nosi od 1998. godine

Hypertensive crisis

Hipertenzivna kriza je stanje akutnog i produženog povećanja krvnog tlaka na vrlo visoke vrijednosti. Prema smjernicama ESH/ESC za liječenje hipertenzije iz 2013. razlikuju se pojmovi hipertenzivne emergencije (eng. hypertensive emergency), koja predstavlja stanje hitnoće u hipertenziji s oštećenjem ciljnih organa (end-organ damage), te hipertenzivne urgencije (eng. hypertensive urgency), koji predstavlja stanje izrazito povišenog krvnog tlaka bez oštećenja ciljnih organa. Točno određenih vrijednosti krvnog tlaka, kojima bi se definirala hipertenzivna kriza, nema. Također, vrijednosti krvnog tlaka pri kojima dolazi do hipertenzivne emergencije s oštećenjem ciljnih organa, ovise o individualnoj toleranciji visokih vrijednosti krvnog tlaka. Od velike je važnosti točno prepoznati postoji li navedeno oštećenje ciljnih organa, dakle radi li se o hipertenzivnoj emergenciji ili o hipertenzivnoj urgenciji, jer se pristup u zbrinjavanju bolesnika razlikuje između ta dva entiteta te, unutar skupine emergencija, terapija ovisi o organskom sustavu čija je funkcija oštećena. Pacijenti s hipertenzivnom emergencijom, kao težim od dva oblika krize, zbrinjavaju se u jedinicama intenzivnog liječenja uz parenteralnu primjenu antihipertenzivnih lijekova, što kod pacijenata s hipertenzivnom urgencijom nije potrebno. Glavni cilj liječenja je sniziti vrijednosti krvnog tlaka, no uz oprez, postepeno i do određene granice, da ne bi došlo do daljnje hipoperfuzije i time do progresije oštećenja ciljnih organa. U prevenciji razvoja hipertenzivne krize potrebna je adekvatna kontrola hipertenzije kod bolesnika što se postiže promjenom životnih navika te uz pomoć medikamentozne terapije. Ključan je čimbenik suradljivost pacijenta, redovita kontrola i uzimanje antihipertenzivne terapije.In hypertensive crisis there is an acute and prolonged rise in blood pressure to very high values. According to 2013. ESH/ESC guidelines for the management of arterial hypertension, there are two different entities in hypertensive crisis, hypertensive emergency which is associated with impending or progressive end-organ damage, and hypertensive urgency, which is defined as isolated large blood pressure elevation without end-organ damage. There are no exact blood pressure values that would define hypertensive crisis. Also, blood pressure values with which hypertensive emergency, including end-organ damage, would develop, depend on each patients own ability to tolerate high values of blood pressure. It is very important to recognize if there is end-organ damage present, so we can differentiate between hypertensive emergency and urgency because there is a considerable difference in treating these hypertensive crisis entities. Also, treatment of hypertensive emergencies depend on the type of end-organ damage present. Patients with hypertensive emergency should be managed in an intensive care unit with antihypertensive drugs given parenterally, which is not necessary in patients with hypertensive urgency. The main treatment goal is to reduce blood pressure values, but this should be done carefully, gradually and to a certan level, so further hypoperfusion and progression of end-organ damage is avoided. Prevention of hypertensive crisis is done by treating pre existing hypertension which is achieved by lifestyle changes and medication therapy. Patient compliance is the key, including regular check-ups and taking the medications exactly as prescribed