A clinical study of hypertensive emergencies

Background: Hypertensive crisis is characterized by high blood pressure that is highly likely to cause pressure against the arterial walls causing chronic cardiovascular diseases. It has caused higher mortality and morbidity rates in both adults and children in equal measures. Hypertensive emergency is scientifically believed to cause several vital organ failures. The current study aims to critically evaluate hypertensive emergencies and the spectrum of end-organ damage due to risk factors of hypertensive emergencies.Methods: This prospective study was conducted on 150 patients with a severe arterial blood pressure of >180/120 mmHg) admitted at Area hospital, Zaheerabad. The doctors performed a detailed medical and clinical examination on the patients to assess organ damage. 120 patients met the hypertensive emergency (HTN-E), while 30 patients met the hypertensive urgency (HTN-U).Results: Patients who reported signs of HTN-E were older adults who are more sedentary, highly intensive smokers, and non-adherent to all forms of hypertensive medications that those with HTN-U. Most of the HTC-U patients had a known history of hypertension than HTC-E. There is about 2% prevalence of hypertensive crisis while admitted at the ICU.Conclusions: Early assessment of the level of organ damage is key in regulating severe complications of hypertension.

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Clinical study of hypertensive crisis at a tertiary care hospital of South India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183831 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1168

Author(s):

M. Sai Varun ◽

Usham Gangaram ◽

M. V. Nagabushana ◽

H. G. Revana Siddappa ◽

Bhimasen Soren

Keyword(s):

Blood Pressure ◽

Hypertensive Crisis ◽

Hypertensive Emergency ◽

Common Symptom ◽

Sudden Increase ◽

Care Hospital ◽

Hypertensive Urgency ◽

Adequate Treatment ◽

Arterial Blood ◽

Study Results

Background: Hypertensive crisis is a severe clinical condition in which sudden increase in arterial blood pressure can lead to acute vascular damage of vital organs. So timely detection, evaluation and adequate treatment are crucial to prevent permanent damage to vital organs. The aim of the present study is to evaluate incidence and clinical presentation of hypertensive crisis in relation to age, sex, severity of hypertension, accompanying symptoms and clinical manifestations.Methods: It is a clinical prospective study done during the period between January to June 2018 at Narayana Medical College, Nellore. All patients who were more than 18 years with blood pressure>180/120 mmHg to the emergency, outpatients, and inpatients were included. A thorough History and clinical examination was done and necessary investigation was sent to the laboratory.Results: The study results indicate that males (64%) were significantly over represented compared to females (36%). Out of 50 patients majority of the subjects belonged to age group of 50-59 years. Out of 50 Patients most common symptom is Headache (48%), Vomiting (48%), Giddiness (38%), Dyspnoea (22%), Loss of consciousness (22%) followed by chest pain (20%), Blurring of vision (20%) and weakness of limbs (14%). Most of the individuals are in the hypertensive emergency (66%) followed by Hypertensive urgency (34%). Out of 50 patients 56% had neurological involvement and 44% had cardiological involvement. Our study states that most of cases were in grade 1retinopathy (8%) followed in order by grade 4 retinopathy (8%), grade 2 retinopathy (6%) and grade 3 retinopathy (6%).Conclusions: The present study concludes that majority of patients present presenting in hypertensive emergency belonged to fifth and sixth decades of age. So, treating physician should rapidly assess the differentiation of hypertensive emergency and hypertensive urgency in order to prevent end organ damage and to prevent further morbidity and mortality.

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An Updated Review of Hypertensive Emergencies and Urgencies

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2018-0013 ◽

2018 ◽

Vol 4 (2) ◽

pp. 73-83 ◽

Cited By ~ 1

Author(s):

Katalin Makó ◽

Corina Ureche ◽

Zsuzsanna Jeremiás

Keyword(s):

Target Organ Damage ◽

Hypertensive Crisis ◽

Organ Damage ◽

Secondary Hypertension ◽

Sudden Increase ◽

End Organ Damage ◽

Hypertensive Emergencies ◽

Arterial Blood ◽

Assessment And Treatment ◽

Hypertensive Urgencies

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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Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v13i1.39591 ◽

2022 ◽

Vol 13 (1) ◽

pp. 66-72

Author(s):

Navtej Singh ◽

Tarun ◽

Ravinder Pal ◽

Ankit Chamoli

Keyword(s):

Clinical Presentation ◽

Target Organ Damage ◽

Tertiary Care ◽

Hypertensive Crisis ◽

Organ Damage ◽

Hypertensive Emergency ◽

Time Interval ◽

Care Hospital ◽

Hypertensive Urgency ◽

Cross Sectional

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.

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Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

Brain Sciences ◽

10.3390/brainsci11010070 ◽

2021 ◽

Vol 11 (1) ◽

pp. 70

Author(s):

Mariagiovanna Cantone ◽

Giuseppe Lanza ◽

Valentina Puglisi ◽

Luisa Vinciguerra ◽

Jaime Mandelli ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Hypertensive Crisis ◽

Intravenous Thrombolysis ◽

Strong Relationship ◽

Organ Damage ◽

Cerebrovascular Diseases ◽

Narrative Review ◽

Cerebrovascular Event ◽

Hypertensive Urgency

Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.

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ESC Council on hypertension position document on the management of hypertensive emergencies

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvy032 ◽

2018 ◽

Vol 5 (1) ◽

pp. 37-46 ◽

Cited By ~ 41

Author(s):

Bert-Jan H van den Born ◽

Gregory Y H Lip ◽

Jana Brguljan-Hitij ◽

Antoine Cremer ◽

Julian Segura ◽

...

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Organ Damage ◽

Hypertensive Emergency ◽

Acute Hypertension ◽

Large Arteries ◽

Hypertensive Emergencies ◽

Drug Of Choice ◽

Target Organs ◽

Very High

Abstract Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowered. Key target organs are the heart, retina, brain, kidneys, and large arteries. Patients who lack acute hypertension-mediated end organ damage do not have a hypertensive emergency and can usually be treated with oral BP-lowering agents and usually discharged after a brief period of observation.

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Der hypertensive Notfall

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/s-0043-105516 ◽

2017 ◽

Vol 142 (19) ◽

pp. 1437-1445

Author(s):

Gerd Bönner

Keyword(s):

Blood Pressure ◽

Organ Damage ◽

Hypertensive Emergency ◽

Organ Involvement ◽

Hypertensive Urgency ◽

Induced Hypotension ◽

Rapid Action ◽

Life Threatening ◽

Acute Increase

AbstractHypertensive urgency and hypertensive emergency are associated with sudden, massive rise in blood pressure. An acute increase in blood pressure to values above 180/120 mmHg is considered critical. If not treated in time, it can quickly enter a life-threatening hypertensive emergency. The symptoms or organ damage determine the assessment as a crisis or an emergency. Rapid action is required. The therapy depends on the severity and the organ involvement. However the general principal is to avoid therapeutically induced hypotension.

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Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

Journal of Clinical Medicine ◽

10.3390/jcm9072201 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2201

Author(s):

Fabrizio Vallelonga ◽

Federica Carbone ◽

Francesco Benedetto ◽

Lorenzo Airale ◽

Silvia Totaro ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Scientific Evidence ◽

Organ Damage ◽

Hypertensive Emergency ◽

Uncontrolled Hypertension ◽

Diagnostic Strategy ◽

Hypertensive Emergencies ◽

Hypertensive Disorders ◽

Artery Disease

Background: A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders. Methods: Data from 718 patients presenting to the emergency department of the “Città della Salute e della Scienza” Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed. Results: A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity. Conclusion: Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.

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Pulsed and Tissue Doppler Echocardiographic Changes in Hypertensive Crisis with and without End Organ Damage

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s8094 ◽

2011 ◽

Vol 4 ◽

pp. OJCS.S8094

Author(s):

Taysir Garadah ◽

Salah Kassab ◽

Saleh Gabani ◽

Ahmed Abu-Taleb ◽

Ahmed Abdelatif ◽

...

Keyword(s):

Blood Pressure ◽

Hypertensive Crisis ◽

Organ Damage ◽

Tissue Doppler ◽

Male Gender ◽

Hypertensive Urgency ◽

End Organ Damage ◽

Left Ventricle Hypertrophy ◽

History Of ◽

Ventricle Hypertrophy

Background Hypertensive crisis (HC) is a common medical emergency associated with acute rise in arterial blood pressure that leads to end-organ damage (EOD). Therefore, it is imperative to find markers that may help in the prediction of EOD in acute hypertensive crisis. Aim To assess the clinical presentations on admission; echocardiographic changes of pulsed and tissue Doppler changes in EOD patients compared with no EOD; and the risk of developing end organ damage for clinical and biochemical variables in hypertension crisis. Material and Methods The data of 241 patients with hypertensive crisis with systolic blood pressure (SBP) of >180 mmHg or diastolic blood pressure (DBP) >120 mmHg were extracted from patients files. Patients divided into hypertensive emergency (HE) with EOD, n = 62 and hypertensive urgency (HU) without EOD, n = 179. LV hypertrophy on ECG, echo parameters for wall thickness, left Ventricular mass index (LVMI), Body mass index (BMI), pulse Doppler ratio of early filling velocity E wave to late A wave (E/A) and ratio of E wave velocity to tissue Doppler Em to E wave (E/Em) were evaluated. Serum creatinine, hemoglobin, age, gender, body mass Index (BMI), history of diabetes mellitus, smoking, hypertension, stroke and hyperlipidemia were recorded. Multiple logistic regression analysis was applied for risk prediction of end organ damage of clinical variables. Results Patients with HE compared with HU were significantly older, with a significantly higher SBP on admission, high BMI and LVMI. Further there were significantly higher E/A ratio on Doppler echo and higher E/Em ratio on tissue Doppler echocardiogram. Multiple regression analysis with adjustment for age and sex shows positive predictive value with odds ratio of SBP on admission >220 mmHg of 1.98, serum creatinine > 120 µg/L of 1.43, older age > 60 year of 1.304, obesity (BMI ≥ 30) of 1.9, male gender of 2.26 and left ventricle hypertrophy on ECG of 1.92. The hemoglobin level, history of smoking, hyperlipidemia and DM were with no significant predictive value. The pulsed Doppler E/A ratio was ≥1.6, E/Em > 15, LVMI > 125 gm/m2 in patients with EOD compared with those without. Conclusion In patients presented with hypertensive crisis, the echo indices of E/A ratio and E/Em ratio of tissue Doppler are significantly higher in patients with hypertensive emergency compared to hypertensive urgency. The left ventricle hypertrophy on ECG, high LV mass index of >125 gm/m2, BMI > 30, old age > 60 year, male gender and history of hypertension and stroke were positive predictors of poor outcome and end organ damage.

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Clinical bases of the syndrome of hypertensive crisis in the primary care

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.1.2021.225725 ◽

2021 ◽

Vol 17 (1) ◽

pp. 72-88

Author(s):

J.E. Vásquez Abanto ◽

A.E. Vásquez Abanto ◽

S.B. Arellano Vásquez

Keyword(s):

Blood Pressure ◽

Emergency Medicine ◽

Target Organ Damage ◽

Hypertensive Crisis ◽

Target Organ ◽

Hypertensive Emergency ◽

Necessary Condition ◽

Outpatient Basis ◽

Hypertensive Urgency ◽

First Case

Hypertensive crisis is a common occurrence at the level of all primary healthcare. One of the main tasks in the diagnosis and treatment of a hypertensive crisis in emergency medicine is the ability to differentiate between a hypertensive emergency and urgency, based on the presence of damage to the target organ in the first case. An appropriate stratification, prevention, and regression of the damage caused by hypertensive crisis could prevent future events in the long term. The states of hypertensive urgency (uncomplicated hypertensive crisis) are usually not associated with an immediate risk to life, so treatment can be started, even completed, on an outpatient basis. Hypertensive emergency conditions (complicated hypertensive crisis) are very serious clinical situations that require hospitalization. In a case of severe hypertension in a patient, asymptomatic or with non-specific symptoms, a cautious therapeutic approach should be taken. When treating conditions of hypertensive urgency, the efforts of physicians are aimed both at lowering blood pressure (at least 20 % of the baseline) and avoiding its sudden and/or excessive decrease (it is necessary to maintain penumbra zone). Therefore, fast-acting drugs should not be used because of the risk of ischemic events. In the case of hypertensive emergency conditions, the choice of drugs should be individual, and the parenteral route of administration is the most common form. In the absence of symptoms of target organ damage, most of the patients are likely to be treated on an outpatient basis. Compliance with a clear continuity of diagnostic and therapeutic measures at the prehospital stage and in the hospital is a necessary condition for the real stabilization of this state. Emergency conditions associated with a hypertensive crisis are the main reasons for contacting and/or calling the physician of emergency medicine in Ukraine (≈ 25–26 %). Hypertensive crisis, the primary manifestation or complication of a previously diagnosed arterial hypertension, most often can occur as a severe increase in blood pressure ≥ 180/120 mm Hg (although the clinical picture of hypertensive crisis is sometimes observed with lower numbers). The literature search methods are as follows Scopus database, Web of Science, MedLine, CyberLeninka, RISC.

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Abstract T3: Type 2 Myocardial Infarction Predicts Outcome In Hypertensive Crisis Patients: Nationwide Analysis

Hypertension ◽

10.1161/hyp.78.suppl_1.t3 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Ahmed M Maraey ◽

Ahmed Elzanaty ◽

Hadeer R Elsharnoby ◽

Mahmoud Salem ◽

Mahmoud Khalil ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Hypertensive Crisis ◽

Primary Diagnosis ◽

Hypertensive Emergency ◽

Secondary Outcome ◽

Hypertensive Urgency ◽

Emergency Presentation ◽

The Impact

Background: Type 2 Myocardial infarction (T2MI) can occur in hypertensive crisis patients. The impact of T2MI in this population is poorly understood due to limited available data. Objective: To assess the impact of T2MI on patients admitted to the hospital with hypertensive crisis. Methods: We queried National Readmission Database (NRD) of year 2018 for adult patients admitted with a primary diagnosis of hypertensive crisis. Patients were excluded if they had type 1 myocardial infarction (T1MI), septic shock, or bleeding in the index admission. Primary outcome was 90-day readmission due to T1MI. Secondary outcome was in-hospital mortality. Subgroup analysis was done according to urgency and emergency presentation. Multivariate regression was done to account for confounders. Results: A total of 101211 patients were included in our cohort of whom 3644 (3.6%) were diagnosed with T2MI and 24471 (24.2%) were readmitted within 90 days of discharge. Of those, 912 (3.7%) were diagnosed with T1MI on readmission. T2MI was independently associated with increased odds of 90-day readmission with T1MI (Adjusted odds ratio (aOR): 2.67, 95% CI [1.91-3.75], P=0.000). T2MI effect was observed in hypertensive urgency, and in hypertensive emergency. T2MI was associated with increased in-hospital mortality in hypertensive urgency population (aOR: 4.21, 95% [1.58-11.25], P=0.004) but not in hypertensive emergency (table 1). Conclusion: In hypertensive crisis patients, T2MI was associated with increased 90-day readmission with T1MI. Aggressive management of cardiovascular risk factors and risk stratification should be considered at the time of diagnosis.

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