What injections are given intramuscularly to reduce high blood pressure?


Types of medications for injections

Medicines that lower blood pressure are conventionally divided into types:

  1. Diuretics. These are diuretics that remove excess fluid from the body along with urine.
  2. Angiotensin-converting enzyme inhibitors. Blockers of factors that increase blood pressure. They are well tolerated by patients, the pressure decreases gradually. Prescribed to older people.
  3. Peripheral vasodilators. Relaxes the muscles of blood vessels. Can even be used by pregnant women. The drugs are administered intravenously.


Injections against high blood pressure in emergency cases (for example, during a hypertensive crisis) can save lives

Video on the topic

What injections for high blood pressure are considered the most effective? Answer in video:

Despite the fact that injections for high blood pressure have a quick effect, they cannot become a permanent way to eliminate hypertension. Firstly, because their effect can be considered immediate, that is, injections reduce blood pressure, giving a temporary result, but do not in any way affect the treatment of the disease itself.

Secondly, the medications included in one or another type of injection for blood pressure have many side effects and should be selected with caution if the patient has other concomitant diseases.

Thirdly, injections to reduce blood pressure are one of the most painful methods, in which there is a risk of infection from the external environment and the likelihood of injury to the injection site. The only adequate way to maintain normal blood pressure levels should be complex therapy, subject to maintaining a correct lifestyle and adhering to a specially prescribed diet.

The information on the MyMedNews.ru website is for reference and general information, collected from publicly available sources and cannot serve as a basis for making a decision on the use of medications in the course of treatment.

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Treatment of hypertension

The fight against high blood pressure is a complex therapy. It consists of systemic administration of medications. These can be tablets or injections. The course of treatment is selected by a specialist based on the symptoms and severity of the disease. Do not self-medicate. After all, high blood pressure is very dangerous.

The dosage of medications is selected individually for each patient, and both the medication and the dose may change during the process.

For a long-term effect, it is recommended to use long-acting drugs, since these drugs have a gentler effect on the body.

You can also use several medications at once, but in very minimal dosages. This intake reduces the occurrence of side effects and prolongs the effect of drugs that lower blood pressure.

Treatment at home

Treatment of hypertension at home cannot be done without a doctor. The specialist selects a course of treatment in the form of tablets. Inconsistent or incorrect use of medications can provoke a hypertensive crisis. Treatment should be systemic; it is advisable to take medications daily, at the same time.

To quickly reduce blood pressure, the help of emergency specialists is required, who decide which injection to give to the patient for a quick effect. The decision depends on the pressure readings, age and condition of the patient. Injections that lower blood pressure can be given either intravenously or intramuscularly.

If you have any allergic reactions to medications, be sure to notify emergency personnel.

Adequate treatment will help prevent hypertensive crisis and will positively affect the patient’s quality of life

Treatment in hospital

In case of a severe hypertensive crisis, after first aid is provided, the patient may be admitted to a hospital for further treatment. Pressure is about 220/120 mmHg. Art. very dangerous. After a hypertensive crisis, there may be complications and damage to internal organs, as well as a heart attack or stroke.

Treatment in a hospital differs from home therapy and consists mainly of injections. Treatment is carried out under constant supervision of medical personnel.

Injections that are used for inpatient treatment are:

  • “Clonidine”, “Nifediline” - equalizes blood pressure for 5-6 hours, reducing it by 20% in the first two hours;
  • "Eufilin" - restores breathing;
  • “Nitroglycerin” (0.1%) is diluted with saline and administered by drop method. This is a vasodilator drug. It works to reduce blood flow to the heart;
  • "Metaprolol" - reduces the strength and frequency of heart contraction;
  • “Lasix”, “Captopril” - administered dropwise or once. The doctor calculates the dose. There may be side effects such as vomiting and nausea;
  • "Relanium" - relieves muscle spasm of the heart;
  • “Sodium nitroprusside” is administered by drip for heart failure under the supervision of doctors. This drug can dramatically lower your blood pressure.

During a hypertensive crisis, there may be cerebral or pulmonary edema, stroke, or heart attack. Therefore, intensive therapy is carried out until the results are stable, and only then the patient is discharged home.

When choosing injections, it is necessary to study all the prerequisites that led to an increase in blood pressure

Helping the patient before the ambulance arrives

When providing first aid at home, it is important to measure blood pressure every 10-15 minutes. It is advisable to record all received data. This will help you quickly navigate the dynamics of changes in blood pressure. Basic actions:

  1. Calm the patient. This will help reduce the stress on the nervous system. Give the patient to take some sedative: tincture of motherwort, valerian, Corvalol.
  2. Restore breathing. To do this, ensure an influx of fresh air, release the carotid artery from compression by clothing: unfasten the buttons on the collar, remove tight-fitting clothing. Take deep breaths and exhales.
  3. Take a semi-sitting position. Lower your legs below body level, place a pillow under your back and lean your elbows comfortably on it.
  4. Direct blood flow to the lower part of the body: apply a heating pad to the legs, mustard plasters to the calves, place the legs in warm water, and a cold compress or bag of ice to the head.
  5. Breast massage should only be performed by a trained person to avoid harm to the patient.
  6. For heart pain, take nitroglycerin. If the effect does not occur within 10 minutes, take another tablet, but no more.

It is better for people with hypertension to take medications that were previously prescribed. If you are providing assistance to those who are experiencing high blood pressure for the first time, you cannot be guided by the principle: what has helped others will help anyone. In this case, it is highly undesirable to give medicine; it is better to wait for medical workers. Only an ambulance team equipped with special equipment is able to identify the cause of a jump in blood pressure in a patient.

What universal means are used to reduce blood pressure?

The most popular remedy is the so-called triad. The composition of this “cocktail” includes: “Papaverine”, “Diphenhydramine”, “Analgin”. These drugs are taken in an ampoule, because the dosage and percentage have already been thought out by the manufacturers of the drug.

These medications may be mixed or administered alternately:

  • “Papaverine” – relaxes arteries, improves blood circulation, relieves attacks, relieves pain. At the same time, the blood flow to the internal organs does not change. “Papaverine” can be replaced with a similar drug “No-shpa”, the basis of which is drotaverine, but it only relieves spasm of smooth muscles;
  • "Analgin." This is a fast-acting pain reliever;
  • "Diphenhydramine." A sedative that restores blood pressure and heart rhythm. A side effect is drowsiness.

The use of this “cocktail” does not treat hypertension, but only temporarily reduces blood pressure. To combat hypertension, you need to see a doctor for diagnosis and treatment.

Triad is very popular among emergency doctors, because the injection of these drugs quickly lowers blood pressure.

Combination drugs

Vasospasm can cause high blood pressure, and Papaverine (2 ml) and Dibazol (4 ml) are used. These drugs are administered intramuscularly and done as slowly as possible.

Sudden changes in blood pressure wear out the heart and blood vessels, so you can’t rely only on injections

If high blood pressure is accompanied by severe headaches, then analgin is added to these drugs.

All medications and their dosage are calculated by the doctor.

Administration of hot injections

Hot injections are used when there is a threat of hypertensive crisis. They are injected into a vein over 3–5 minutes.

Hot injections have a number of advantages:

  • fast action;
  • vasodilator effect;
  • increase blood flow speed;
  • diuretic effect.

Magnesia - instructions for use

One of the most popular injections is magnesium sulfate, which is called magnesia. It is administered intramuscularly. The injection is quite painful, so it is supplemented with novocaine.

Hot injections are effective for a sharp increase in blood pressure

To correctly administer the drug, there are rules:

  1. Magnesia is administered with a thin needle, the length of which is more than 4 centimeters.
  2. The drug is first warmed up in your hands.
  3. Enter gently and slowly.

Magnesia can be injected both intravenously and intramuscularly. This is decided by the doctor. When used intravenously, the result appears immediately, when administered intramuscularly in about an hour. It is prohibited to inject magnesium into the stomach.

Indications: high blood pressure, hypertensive crisis, epileptic attacks, urinary retention, concussions, bronchial asthma.

Contraindications: renal failure, bradycardia, individual intolerance.

"Actovegin" - how to use it for hypertensive patients

The active component of this drug (hemoderivat) has a neuroprotective and metabolic effect. The drug "Actovegin" is used for blood pressure of 140/90 mmHg. Art. and above by the drip method.

Indications: high intracranial pressure, trophic ulcer, brain diseases.

Contraindications: pulmonary edema, heart failure, anuria, hypersensitivity.

When using this drug, rapid heartbeat, vomiting, diarrhea, anaphylactic shock, and dizziness are possible.

A hypertensive crisis is dangerous with the risk of developing cerebral or pulmonary edema, stroke or heart attack

"Mexidol"

The active substance of the drug - ethylmethylhydroxypyridine succinate - has an antioxidant, membrane-stabilizing, nootropic effect.

Mexidol is intended for both intramuscular and drip use.

Do not use in case of renal and liver failure, pregnancy, lactation, or individual intolerance.

Side effects: dry mouth, drowsiness, allergic reactions.

Contraindications and side effects

Despite the effectiveness of hot injections for the treatment of hypertensive crises, injections should not be given if renal failure and heart block are diagnosed. Therapy is contraindicated for glaucoma and open bleeding in the gastrointestinal tract. People over 60 years of age should approach injections with caution, as there is a risk of a sharp rise in temperature. Side effects include dizziness, increased blood flow to the head, sinus rhythm disturbance and nausea. Discomfort usually goes away within 15-30 minutes.

Additional recommendations

For hypertensive patients, the main thing is to prevent the disease; sudden surges in pressure wear out the cardiovascular system.

Therefore, you need to follow simple rules:

  • Monitor your blood pressure readings regularly. Be sure to measure it in the morning and evening. If there is a significant increase in pressure, immediately call an ambulance;
  • do not take a hot bath or go to the sauna;
  • to refuse from bad habits;
  • take vitamins;
  • follow a diet.

High blood pressure injections are an urgent aid for a hypertensive crisis. And it is very important to receive this help on time. Diseases of the heart and blood vessels are very dangerous, so prevention of the disease is better than its consequences. Monitor your health and seek medical help on time.

Medicines to improve blood circulation

Peripheral circulation is a continuous process of blood circulation in small veins and arteries, capillaries, as well as arterioles and venules. A variety of factors lead to impaired blood circulation, including: tumors, injuries, heart and vascular diseases, kidney diseases, metabolic disorders, etc.

Signs of poor circulation may include: pain in the legs, swelling, discoloration of the limbs, headaches, hearing problems, imbalance, numbness in the limbs, etc.

Treatment of poor circulation

When blood circulation is impaired, the following diseases occur:

  • arterial and venous hyperemia
  • thrombosis
  • ischemia
  • stasis
  • embolism
  • varicose veins
  • Raynaud's disease

For treatment, it is necessary to accurately determine the cause and, depending on it, prescribe medication. For acute problems, surgery may be required. In addition, treatment must be combined with proper nutrition (eating foods low in fat and salt), giving up bad habits (smoking and alcohol) and undergoing special procedures to improve blood flow (vibration therapy, electromagnetic therapy, etc.).

Medicines to improve blood circulation

The following groups of drugs are used to improve blood circulation:

1) Drugs that improve microcirculation - this group of drugs acts on the vessels of the microcirculation. As a result, the vessels dilate and the blood becomes less viscous. As a rule, drugs of this group are used for circulatory disorders due to various diseases (diabetes mellitus, atherosclerosis):

  • radomin
  • chime
  • pentoxifylline
  • trental
  • Vasonite

2) Prostaglandin E1 drugs - drugs in this group have a positive effect on microcirculation and blood flow, and also have a hypotensive effect: vazaprostan

3) Calcium channel blockers are mainly used to improve blood circulation in the brain. Helps improve vascular microcirculation and limit damage to brain tissue. These include:

  • cinnarizine
  • logmax
  • nafadil
  • nimotop
  • cinnasan
  • brainal
  • norwax
  • arifon
  • cordipin
  • phoridon
  • Nifecard
  • cordafen

4) Low molecular weight dextran preparations - drugs of this group have a positive effect on blood fluidity by attracting additional volumes of blood from the intercellular space. These include:

  • rheomacrodex
  • hemostabil
  • rheopolyglucin

5) Myotropic antispasmodics - this group of drugs dilates blood vessels and relaxes smooth muscles. Myotropic antispasmodics show high effectiveness in cerebral vascular spasms:

  • spasmol
  • halidor
  • mydocalm

6) Herbal medicines are preparations that are created on the basis of plant materials. Herbal medicines show high effectiveness in cerebrovascular diseases, as well as in obliterating atherosclerosis and endarteritis. These include:

  • bilobil
  • tanakan

7) Alpha adrenergic blockers - drugs of this group contribute to better blood supply to peripheral tissues. These include:

  • phentolamine
  • prazosin
  • sermion

8) Ganglion blockers - these drugs improve blood circulation in the lower extremities and also have a pronounced hypotensive effect (lower blood pressure):

  • pyrylene
  • Temekhin
  • dimecoline
  • pachycarpine

9) Bioflavonoids are substances of plant origin that increase blood flow and improve the condition of blood vessels:

  • venoruton
  • antoxide

10) Dopamine receptor stimulants - this group of drugs acts on dopamine receptors, which, in turn, leads to vasodilation. Improves blood circulation in the lower extremities - pronoran.

Drugs for the treatment of the cardiovascular system

The modern pharmaceutical industry is using every opportunity to meet the demand for medicines. The consumer or buyer are sick people. The pharmacy retail chain perfectly takes into account the fact that a person is trying to get rid of cardiovascular problems by all available means. The advertised list of heart medications includes everything that needs to be “sold.” Very often, a well-functioning sales system pushes completely ineffective pills. Therefore, it is not recommended to choose medications on your own to treat any disease, especially for the heart.

Intracranial hypertension

When intracranial pressure increases, Mexidol is used. Most often the condition is diagnosed in women.

Mexidol injections are indicated for intracranial hypertension

Indications for use (in addition to reducing ICP):

Diuretics for hypertension

  • cerebral circulatory disorders;
  • TBI (traumatic brain injury) and its consequences;
  • encephalopathy;
  • VSD (vegetative-vascular dystonia);
  • minor cognitive impairment;
  • anxiety against the background of neurotic and neurosis-like conditions;
  • acute period of myocardial infarction;
  • primary open-angle glaucoma;
  • elimination of withdrawal symptoms;
  • acute poisoning with antipsychosomatic drugs.

Contraindications are:

  • serious disturbances in the functioning of the kidneys and liver;
  • hypersensitivity to the components of the product;
  • childhood;
  • period of bearing a child.

Important! Mexidol is administered intramuscularly or intravenously (stream or drip).

Side effects:

  • attacks of nausea;
  • dry mouth;
  • increased drowsiness;
  • allergic symptoms.

Tablets #171;ambulance#187; at high pressure

Today, high blood pressure is a common disease. It worries not only older people, but also young people. The total number of people suffering from the disease is more than 35% of the Russian population.

Hypertension is a consequence of increased blood pressure as it pumps against the walls of the arteries. Such a process will certainly affect the general condition of a person. He experiences discomfort and a lot of unpleasant sensations. Its main symptoms include headache, nausea, tinnitus, and spots in the eyes.

At first glance, this pathology is harmless, but, as practice shows, it can have unpleasant consequences. For example, lead to the death or disability of the patient. It follows that at the first manifestations of hypertension it is necessary to take measures to eliminate it.

This disease can occur in either a mild or chronic form. To treat the first, it is enough to take a course of pharmacological medications. For chronic hypertension, drug therapy is inevitable. It is mainly prescribed to people whose age exceeds 43 years. At the same time, they may have a number of other chronic diseases, and they are predisposed to stroke or heart attack.

People who know about their illness should always have pills on hand that will help restore blood pressure. After all, it can take you by surprise anywhere, and if the necessary procedures are not followed, the person’s condition will become critical. In very difficult cases this can even lead to death. If there are no tablets at hand, you should immediately call an ambulance. Your doctor will help you lower your blood pressure.

If after an examination you are diagnosed with hypertension, then the first thing you need to do is pay attention to your lifestyle. It must be correct. This is especially true for diet. Experts recommend that patients with hypertension follow a diet, since excess weight can lead to increased blood pressure. Therefore, it is necessary to restore it to normal. In addition, limit salt in food, stop drinking alcohol, and stop smoking. All these habits have a detrimental effect on the well-being of hypertension.

When to take the pills

People with high blood pressure should take special tablets regularly. This will eliminate the possibility of increased pressure. As practice shows, the most favorable time is considered to be evening. This is explained simply. Mostly, high blood pressure is observed in the morning, as soon as a person wakes up and begins to be active. To avoid this, just take the pill in the evening. Its effect will be much more noticeable in the morning, the pressure will normalize.

What types of pills to take for high blood pressure

High blood pressure is a complex type of disease. It can cause a heart attack. Therefore, his treatment must be carried out correctly. Otherwise, unpleasant consequences cannot be avoided. So, a sharp drop in pressure is undesirable. It can negatively affect a person’s overall well-being, so it should be strictly under medical supervision. But the best option is to slowly drop the pressure.

Today, the choice of tablets whose action is aimed at solving this problem is quite extensive. You can verify this by going to any pharmacy. But experts do not recommend self-medication. Since what suits one person is not a fact that it will be effective for another, therefore you should seek medical help. So, after a complete examination, the doctor will prescribe the necessary medicine. If it turns out to be ineffective, then another will suggest. Such cases occur in practice. Tablets may cope with the task well at first, but not after some time.

At the same time, not only the process of their action takes place differently, but also a decrease in pressure. In addition, if the disease is severe, then several of them are used simultaneously. Thus, up to three drugs can be prescribed for complex treatment. In this case, the appointment process occurs only after the cause of high blood pressure has been established.

There are different types of medications that can lower blood pressure. Conventionally, they were divided into several groups depending on their action:

  • diuretics. Such drugs help remove excess fluid, which includes dissolved salts, from the body. Examples of such drugs are Furosemide, Indapamide, etc. For many patients, they work effectively, especially if you lead a correct lifestyle. All this helps control blood pressure for a long time;
  • beta blockers. Such drugs are prescribed in cases where the symptoms of the disease are more pronounced. They act directly on the heart, calming it. This leads to a decrease in pressure. The most famous drugs in this group are Bisoprolol, Leveton, Atenolol and others;
  • blockers targeting receptors. This medicine is distinguished by its speed of action. As for the negative aspects of this group, there are quite a few of them. At the same time, the dosage of their intake is strictly regulated. It is one tablet per day. Its most common representatives include Losartan, Eprosartan, Valsartan, etc.;
  • blockers that act on calcium channels. Such drugs are aimed at preventing or minimizing the entry of calcium into the vessels and tissues of the heart. At the same time, their tolerance by the body is quite good. Examples of drugs in this group are Nifedipine, Adalat, Cardizem, Amlodipine, Norvasc. However, some can adversely affect the functioning of other organs, mainly the kidneys or legs. On the latter, swelling appears;
  • inhibitors of an enzyme that has the property of angiotensin conversion. Medicines in this group are considered the most effective for lowering blood pressure. They act quickly and for a long time. At the same time, they do not lead to various complications due to hypertension. Mainly prescribed are Captopril, Berlipril, Altan, etc. But there is one negative side to this medicine. It can cause an allergic cough.

Of course, like any medicine, data also has its side effects. As practice shows, this is inevitable. But there are ways to help minimize them, which involves using additional medications. This therapy will be called combination therapy.

Most side effects appear immediately. They can be presented in the form of dizziness, lethargy, apathy, headaches, dry mouth, disruption of the gastrointestinal tract and sleep. Men may experience problems with potency.

Therefore, you should not self-medicate. First, you need to consult your doctor. He will determine the cause of the disease and select the most suitable medicine to treat it. If any side effects occur, you should also inform him. He will select a different set of drugs that will effectively cope with the task and be well tolerated by the body.

Pressure injections are a remedy that allows you to achieve a pronounced therapeutic effect very quickly, so they are used when emergency help is required, namely during a hypertensive crisis. As soon as the condition stabilizes, the patient is transferred to tablet forms of medications.

Drawing conclusions

Heart attacks and strokes are the cause of almost 70% of all deaths in the world. Seven out of ten people die due to blockages in the arteries of the heart or brain.

What’s especially scary is the fact that a lot of people don’t even suspect that they have hypertension. And they miss the opportunity to fix something, simply dooming themselves to death.

  • Headache
  • Increased heart rate
  • Black dots before the eyes (floaters)
  • Apathy, irritability, drowsiness
  • Blurred vision
  • Sweating
  • Chronic fatigue
  • Swelling of the face
  • Numbness and chills in fingers
  • Pressure surges

Even one of these symptoms should give you pause. And if there are two of them, then have no doubt - you have hypertension.

How to treat hypertension when there are a large number of medications that cost a lot of money?

Most medications will do no good, and some may even be harmful! At the moment, the only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension is Hyperten.

Until February 26.

The Institute of Cardiology, together with the Ministry of Health, is conducting the “
Izhevsk without hypertension
” program.
Within the framework of which the drug Hyperten is available FREE OF CHARGE
to all residents of the city and region!

Well, I don’t know, but for me most drugs are complete garbage, a waste of money. If only you knew how much I’ve already tried... Only Hyperten helped normally (by the way, you can get it almost free under a special program). I took it for 4 weeks, and after the first week of taking it I felt better. 4 months have passed since then, my blood pressure is normal, I don’t even remember about hypertension! Sometimes I drink the product again for 2-3 days, just for prevention. I actually found out about him by accident, from this article..

Is it worth getting an injection and in what cases?

When hypertension is in crisis, it is difficult for a person far from medicine to choose the right drug and dose that will work optimally. Exceeding the required concentration of the drug leads to a sharp drop in pressure.

Blood pressure can be reduced by no more than 25% of the initial level at one time. Otherwise, a drop in pressure begins, which is called uncontrolled hypotension. In this case, a reduction in cerebral (up to the development of coma) and coronary (angina pectoris, arrhythmia, myocardial infarction) blood circulation often occurs. The worst prognosis is for elderly people with atherosclerosis of the head and neck vessels.

Why don't they give injections?

Until recently, injections were used to treat sudden episodes of high blood pressure (crises). It was possible to quickly reduce high blood pressure to normal. A variety of drugs were administered intravenously and intramuscularly:

  • diuretics;
  • sedatives;
  • Magnesia sulfate, papaverine, and dibazole were traditionally used.

Currently, the negative effects arising from fluctuations in high blood pressure have been authoritatively proven. The rapid rate of decrease in hypertension is accompanied by impaired blood supply to the heart and brain. It can cause stroke, heart attack, kidney failure (with the onset of sudden lumbar pain).

The same fluctuations in numbers with the same consequences that can occur when using injections occur with inadequate treatment with tablets. There may be several reasons:

  1. Medicines chosen incorrectly. There is individual insensitivity to the medication, as happens with ACE inhibitors, or the appearance of side effects in the form of a dry cough. This makes it difficult to use a whole group of drugs.
  2. Inaccurate compliance with cardiologist's instructions. The patient’s independent change in the dosage and time of taking medications leads to periodic high blood pressure.
  3. With hypertension, other diseases may appear, due to which the increase in pressure becomes uncontrollable. For example, urolithiasis occurs for the first time or chronic pyelonephritis worsens (lumbar pain is accompanied by frequent urination and fever). Such situations require contacting a doctor and adjusting treatment after additional examination.

Why is it necessary to reduce blood pressure?

Arterial hypertension is a widespread disease. According to medical statistics, approximately 20-30% of people aged 40 years and older face the problem of high blood pressure. A few decades ago, arterial hypertension was mainly observed in older people; now it is often found even in adolescents.

When blood pressure rises, a person’s well-being worsens significantly. He begins to complain of headache, nausea, and decreased performance. When high blood pressure persists for a long time, the blood supply to the brain and internal organs is disrupted, their function suffers, which can lead to serious consequences for the body.

We offer you to watch a video on the topic of the article.

What blood pressure is considered life-threatening and requires immediate administration of antihypertensive drugs?

Hypertension is diagnosed if, with two repeated measurements on different days, the patient’s blood pressure is above 140/90 mmHg. Art. According to the values ​​of systolic (SBP) and diastolic (DBP) pressure, the following degrees of hypertension are divided:

Hypertensive crisis (HC) occurs against the background of both normal and high blood pressure. It is characterized by a sudden onset, a significant increase in blood pressure and the appearance or intensification of symptoms. Blood pressure up to 240/140 mm Hg. Art. is also regarded as GC, regardless of whether there are clinical manifestations or not.

Symptoms of uncomplicated HA:

  • intense headache;
  • pain in the heart area;
  • shiver;
  • frequent urge to urinate.

Complicated HA provokes the development of:

  • myocardial infarction;
  • stroke;
  • aortic aneurysm dissection;
  • unstable angina;
  • arrhythmias;
  • eclampsia in pregnant women and women in the postpartum period;
  • acute hypertensive encephalopathy;
  • bleeding.
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