Hypertensive urgencies and emergencies

Abstract A hypertensive crisis is an abrupt and severe rise in the arterial blood pressure (BP) occurring either in patients with known essential or secondary hypertension, or it may develop spontaneously. The most frequent cause for the severe and sudden increase in BP is inadequate dosing or stopping antihypertensive treatment in hypertensive patients. Severe hypertension can be defined as either a hypertensive emergency or an urgency, depending on the existence of organ damage. In hypertensive urgencies, there are no signs of acute end-organ damage, and orally administered drugs might be sufficient. In hypertensive emergencies, signs of acute end-organ damage are present, and in these cases, quickly-acting parenteral drugs must be used. The prompt recognition, assessment, and treatment of hypertensive urgencies and emergencies can decrease target organ damage and mortality. In this review, the definitions and therapeutic recommendations in a hypertensive crisis are presented in the light of the 2017 ACC/AHA Hypertension Guidelines.

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Hypertensive urgencies and emergencies

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0381 ◽

2020 ◽

pp. 3800-3810

Author(s):

Gregory Y.H. Lip ◽

Alena Shantsila

Keyword(s):

Blood Pressure ◽

Renal Impairment ◽

Severe Renal Impairment ◽

Rare Condition ◽

Visual Disturbance ◽

Organ Damage ◽

Renal Diseases ◽

Mild Renal Impairment ◽

Cotton Wool Spots ◽

Hypertensive Urgencies

Hypertensive urgencies and emergencies occur most commonly in patients with previous hypertension, especially if inadequately managed. About 40% of cases have an underlying cause, most commonly renovascular disease, primary renal diseases, phaeochromocytoma, and connective tissue disorders. Hypertensive emergencies occur when severely elevated or sudden marked increase in blood pressure is associated with acute end-organ damage. Malignant phase hypertension is a rare condition characterized by very high blood pressure, with bilateral retinal haemorrhages and/or exudates or cotton wool spots, with or without papilloedema. Presentation is typically with visual disturbance, with or without headaches. Urinalysis may demonstrate proteinuria and haematuria, even in the absence of primary renal disease. Some patients with mild renal impairment at first presentation may improve, or even regain normal renal function, but this is unlikely to occur in those with more severe renal impairment at presentation.

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Abstract 2280: Urine Albumin/creatinine Ratio, Cardiac Structure And Diastolic Function In Patients With Hypertension And Diastolic Dysfunction: The Validd Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_497-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Anil Verma ◽

Rajesh Janardhanan ◽

William L Daley ◽

Susan Ritter ◽

William A Kaye ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Organ Damage ◽

Left Ventricular ◽

Creatinine Ratio ◽

Albumin Creatinine Ratio ◽

End Organ Damage ◽

Urine Albumin ◽

Urine Albumin Creatinine Ratio

Background: Increasing urine albumin/creatinine ratio (ACR) is associated with systemic microvascular damage and increased cardiovascular morbidity and mortality. However, the relationship between albuminuria and left ventricular (LV) diastolic function, an early measure of myocardial end-organ damage in hypertension, has not been well defined. Methods: Urine ACR and echocardiographic measures of LV structure and function were assessed in 384 patients enrolled in the VALsartan In Diastolic Dysfunction (VALIDD) trial with mild hypertension and no heart failure and evidence of diastolic dysfunction based on Doppler assessment of myocardial relaxation velocities. Results: Urine ACR was undetected in 151 (39.3%) subjects, between 1 to 30 mg/g in 194 (50.5%), and > 30mg/g in 39 (10.2%). The mean blood pressure in the cohort was 143.8 ± 16.1/86.2 ± 10.3 mmHg and LV hypertrophy was present in < 4% of enrolled patients. Higher urine ACR was associated with lower annular relaxation velocity (E′), higher E/E′ (Figure ), higher prevalence of concentric LV remodeling and higher NT-ProBNP even after adjusting for age, diabetes, systolic BP, eGFR and LV mass index (LVMi) (p < 0.02 for all associations). Conclusion: Albuminuria is associated with worsening diastolic function in patients with hypertension, and both measures may represent important and modifiable markers of early end-organ damage even in patients with mild blood pressure elevation. E′ stratified by urine albumin creatinine ratio E/E′ stratified by urine albumin creatinine ratio

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Extracellular vesicles as a novel diagnostic and research tool for patients with HTN and kidney disease

AJP Renal Physiology ◽

10.1152/ajprenal.00071.2019 ◽

2019 ◽

Vol 317 (3) ◽

pp. F641-F647 ◽

Cited By ~ 4

Author(s):

Uta Erdbrügger ◽

Thu H. Le

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Kidney Disease ◽

Extracellular Vesicles ◽

Organ Damage ◽

The United States ◽

End Organ Damage ◽

Pressure Threshold ◽

Stage Renal Disease ◽

Blood Pressure Threshold

Hypertension (HTN) affects one in three adults in the United States and is a major risk factor for cardiovascular disease and kidney failure. There is emerging evidence that more intense blood pressure lowering reduces mortality in patients with kidney disease who are at risk of cardiovascular disease and progression to end-stage renal disease. However, the ideal blood pressure threshold for patients with kidney disease remains a question of debate. Novel tools to more precisely diagnose HTN, tailor treatment, and predict the risk of end-organ damage such as kidney disease are needed. Analysis of circulating and urinary extracellular vesicles (EVs) and their cargo (protein and RNA) has the potential to identify novel noninvasive biomarkers that can also reflect a specific pathological mechanism of different HTN phenotypes. We will discuss the use of extracellular vesicles as markers of HTN severity and explain their profile change with antihypertensive medicine and potential to detect early end-organ damage. However, more studies with enhanced rigor in this field are needed to define the blood pressure threshold to prevent or delay kidney disease progression and decrease cardiovascular risk.

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3157 Relationship between abnormal nocturnal blood pressure patterns and end-organ damage following heart transplantation.

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.124 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 52-52

Author(s):

Kris Oreschak ◽

Eugene E. Wolfel ◽

Amrut V. Ambardekar ◽

Christina L. Aquilante

Keyword(s):

Blood Pressure ◽

Heart Transplant ◽

Organ Damage ◽

Left Ventricular ◽

High Risk Population ◽

Study Cohort ◽

End Organ Damage ◽

Study Population ◽

Blood Pressure Patterns ◽

The Relationship

OBJECTIVES/SPECIFIC AIMS: Heart transplant (HTx) recipients are more likely to exhibit abnormal circadian blood pressure (BP) patterns (e.g., lack of nocturnal dip in BP) compared with the general population. Our goal was to assess the relationship between abnormal circadian BP patterns and end-organ damage in HTx recipients. METHODS/STUDY POPULATION: The retrospective study included 30 patients who were ≥ 6 months post-heart transplant and had 24-hour ambulatory BP data collected during a parent study. Nocturnal BP decline was categorized as: ≥10% decline, dipper; <10% decline, non-dipper. The primary end-organ damage outcomes we plan to analyze are left ventricular hypertrophy (LVH), chronic kidney disease (CKD), and proteinuria. The association between nocturnal BP decline and the primary outcomes will be analyzed using logistic regression. RESULTS/ANTICIPATED RESULTS: The study cohort consists of 83% men and 83% Caucasians (mean age=57±14 years; mean time post-transplant =9.0±6.6 years). Systolic and diastolic non-dippers represent 53.3% and 40% of the cohort, respectively. Data are currently being analyzed for the association between nocturnal BP dipping status and LVH, CKD, and proteinuria. These findings will be presented at the conference. DISCUSSION/SIGNIFICANCE OF IMPACT: An understanding of factors, such as abnormal circadian BP patterns, that contribute to the development of end-organ damage following HTx may provide opportunities to improve BP management and prevent adverse complications in this high-risk population.

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Do Obese Individuals With Hypertension Have More Difficult-to-Control Blood Pressure and End Organ Damage Than Their Nonobese Counterparts?

Journal of Clinical Hypertension ◽

10.1111/jch.12532 ◽

2015 ◽

Vol 17 (6) ◽

pp. 466-472 ◽

Cited By ~ 2

Author(s):

Mark David Jesky ◽

Manvir Kaur Hayer ◽

Mark Thomas ◽

Indranil Dasgupta

Keyword(s):

Blood Pressure ◽

Organ Damage ◽

Control Blood Pressure ◽

End Organ Damage

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Sex differences in baroreflex sensitivity, heart rate variability, and end organ damage in the TGR(mRen2)27 rat

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00593.2011 ◽

2011 ◽

Vol 301 (4) ◽

pp. H1540-H1550 ◽

Cited By ~ 19

Author(s):

Megan S. Johnson ◽

Vincent G. DeMarco ◽

Cheryl M. Heesch ◽

Adam T. Whaley-Connell ◽

Rebecca I. Schneider ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Sex Differences ◽

Baroreflex Sensitivity ◽

Organ Damage ◽

Left Ventricular ◽

Loop Analysis ◽

Poincaré Plot ◽

End Organ Damage

The aim of this investigation was to evaluate sex differences in baroreflex and heart rate variability (HRV) dysfunction and indexes of end-organ damage in the TG(mRen2)27 (Ren2) rat, a model of renin overexpression and tissue renin-angiotensin-aldosterone system overactivation. Blood pressure (via telemetric monitoring), blood pressure variability [BPV; SD of systolic blood pressure (SBP)], spontaneous baroreflex sensitivity, HRV [HRV Triangular Index (HRV-TI), standard deviation of the average NN interval (SDNN), low and high frequency power (LF and HF, respectively), and Poincaré plot analysis (SD1, SD2)], and cardiovascular function (pressure-volume loop analysis and proteinuria) were evaluated in male and female 10-wk-old Ren2 and Sprague Dawley rats. The severity of hypertension was greater in Ren2 males (R2-M) than in Ren2 females (R2-F). Increased BPV, suppression of baroreflex gain, decreased HRV, and associated end-organ damage manifested as cardiac dysfunction, myocardial remodeling, elevated proteinuria, and tissue oxidative stress were more pronounced in R2-M compared with R2-F. During the dark cycle, HRV-TI and SDNN were negatively correlated with SBP within R2-M and positively correlated within R2-F; within R2-M, these indexes were also negatively correlated with end-organ damage [left ventricular hypertrophy (LVH)]. Furthermore, within R2-M only, LVH was strongly correlated with indexes of HRV representing predominantly vagal (HF, SD1), but not sympathetic (LF, SD2), variability. These data demonstrated relative protection in females from autonomic dysfunction and end-organ damage associated with elevated blood pressure in the Ren2 model of hypertension.

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