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

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.

scholarly journals A clinical study of hypertensive emergencies

2020 ◽  
Vol 9 (1) ◽  
pp. 49
Author(s):  
Sridhar Reddy Konuganti ◽  
Narsimha Swamy
Keyword(s):  
Blood Pressure ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Hypertensive Emergency ◽  
Early Assessment ◽  
Hypertensive Urgency ◽  
Mortality And Morbidity ◽  
Hypertensive Emergencies ◽  
Arterial Blood ◽  
Organ Failures

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.

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

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.

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

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.

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

Hypertension ◽  
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.

scholarly journals To Determine the Correlation between Anthropometric Variables of Obesity and Hypertension at NGMC: A Tertiary Care Hospital

2018 ◽  
Vol 14 (2) ◽  
pp. 70-74
Author(s):  
Bhawana Neupane Pant ◽  
Manoj Pant ◽  
Rajesh Kumar Goit ◽  
Ashish Neupane ◽  
Ganesh Prasad Neupane ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Hip Circumference ◽  
Specific Population ◽  
Anthropometric Indices ◽  
Arterial Blood ◽  
Skin Fold ◽  
Scientific Validation

Aim: Obesity is associated with the metabolic risk factors such as high blood pressure, body fat abnormality, and glucose intolerance which may influence the morbidity and mortality due to cardiovascular diseases. The present study is to determine the correlation of common anthropometric indices of obesity with blood pressure among population in mid-western region of Nepal. The result will provide us insight on relevant anthropometric indices for predicting hypertension based on linear correlation calculated from our data. Methods: We screened 500 healthy subjects to study the correlation between anthropometric indices and blood pressure.Result: Our result showed strong correlation between Sum of Skin fold, waist circumference, and waist hip ratio with blood pressure (systolic blood pressure, diastolic blood pressure and mean arterial blood pressure). However some of the anthropometric indices like hip circumference and body mass index did not have significant correlation with blood pressure. Conclusion: Provided obesity related morbidity and mortality is burgeoning in our society it is imperative to identify right indicators of cardiovascular disease for specific population. Relevant anthropometric indices can serve as excellent indicators if used based of scientific validation. JNGMC, Vol. 14 No. 2 December 2016, Page:70-74

scholarly journals Glycopenia - induced sympathoadrenal activation in diabetes mellitus and uncontrolled arterial hypertension: an observational study

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Abimbola Abobarin-Adeagbo ◽  
Andreas Wienke ◽  
Matthias Girndt ◽  
Rainer U. Pliquett
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Insulin Dose ◽  
Hypertensive Crisis ◽  
Plasma Norepinephrine ◽  
Arterial Blood ◽  
Group 3 ◽  
Group 2 ◽  
Group 1 ◽  
Diabetes Patients

Abstract Background Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hypertension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypoglycemic episodes than their counterparts without hypertensive crisis on admission. Methods In a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous glucose monitoring, 24-h blood-pressure- and Holter electrocardiogram recordings, and to laboratory tests including plasma catecholamines. Results 53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher body-mass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more documented hypoglycemic episodes (0.8 ± 0.5 per 24 h) than Group-2 patients (0.2 ± 0.3 per 24 h), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 h). Plasma norepinephrine and mean arterial blood pressure were higher Group-1 and Group-3 patients than in control patients of Group 2. At discharge, the daily cumulative insulin dose was reduced in Group-1 (− 18.4 ± 24.9 units) and in Group-3 patients (− 18.6 ± 22.7 units), but remained unchanged in Group-2 control patients (− 2.9 ± 15.6 units). Conclusions An association between hypoglycemic events and uncontrolled hypertension was found in this study.

scholarly journals Glycopenia-Induced Sympathoadrenal Activation in Diabetes Mellitus And Uncontrolled Arterial Hypertension: An Observational Study.

2020 ◽  
Author(s):  
Abimbola Abobarin-Adeagbo ◽  
Andreas Wienke ◽  
Matthias Girndt ◽  
Rainer U. Pliquett
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Insulin Dose ◽  
Hypertensive Crisis ◽  
Plasma Norepinephrine ◽  
Arterial Blood ◽  
Group 3 ◽  
Group 2 ◽  
Group 1 ◽  
Diabetes Patients

Abstract Background: Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hypertension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypoglycemic episodes than their counterparts without hypertensive crisis on admission.Methods: In a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous flash glucose monitoring, to 24-hour blood-pressure and Holter electrocardiogram recordings, and to laboratory tests including plasma catecholamines. Results: 53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher body-mass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more documented hypoglycemic episodes (0.8 ± 0.5 per 24 hours) than Group-2 patients (0.2 ± 0.3 per 24 hours), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 hours). Plasma norepinephrine and mean arterial blood pressure were not different between Group-1 and Group-3 patients, though higher than in Group-2 patients. At discharge, the daily cumulative insulin dose was reduced in Group-1 (-18.4 ± 24.9 units) and Group-3 patients (-18.6 ± 22.7 units), but remained unchanged in Group-2 patients (-2.9 ± 15.6 units).Conclusions: An association between hypoglycemic events and uncontrolled hypertension was found in this study.

scholarly journals Smoking and blood pressure levels in hypertensive patients: evaluating the role of gender, age and hypertension duration

2019 ◽  
Vol 7 (5) ◽  
pp. 1610
Author(s):  
Jameel Ahmed Siddiqui ◽  
Syed Aijaz Zaidi ◽  
Jawed Iqbal ◽  
Nazia Qamar ◽  
Rahila Adil ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Level ◽  
Smoking History ◽  
Care Hospital ◽  
Local Data ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Significance Level ◽  
Study Results

Background: Hypertension is estimated to affect about 40% of adults above 25 years of age globally. While many of the risk factors of hypertension are well known, such is not the case with smoking. Pertinent published literature is heterogeneous, with a dearth of relevant local data. Objectives was to study the relationship between smoking and blood pressure levels in hypertensive patients and to assess the effects of gender, age and hypertension duration on such a relationship.Methods: A cross-sectional study was carried out on a total of 298 conveniently sampled patients, aged 18 or above, from the medical outpatient department of a secondary care hospital of Karachi. The relevant data were collected by means of a structured questionnaire whereas the blood pressure level was checked using sphygmomanometer with stethoscope. Mann Whitney U test was used for inferential analysis whereas the significance level was set at 0.05.Results: Overall, both the systolic and diastolic blood pressure levels were significantly associated with smoking history (p<0.05 for both) where they were found to be higher in smokers than in non-smokers. Furthermore, after gender, age and hypertension duration based stratifications; both the systolic and diastolic blood pressure levels were still significantly associated with smoking history in patients who were male, were ≥35 years old and had <5 years hypertension duration (p<0.05 for both) where they were again found to be higher in smokers than in non-smokers.Conclusions: The study results showed a significant association of positive smoking history with higher mean systolic and diastolic blood pressure levels, though after stratifying for gender, age and hypertension duration, this relationship persisted only in patients who were male, were ≥35 years old and had <5 years hypertension duration.

scholarly journals An Updated Review of Hypertensive Emergencies and Urgencies

2018 ◽  
Vol 4 (2) ◽  
pp. 73-83 ◽  
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.

New approaches to managing patients with hypertensive crisis (sudden increase in blood pressure)

2020 ◽  
pp. 33-40
Author(s):  
Sergey Krayushkin ◽  
Irina Ivakhnenko ◽  
Irina Kolesnikova
Keyword(s):  
Blood Pressure ◽  
Intensive Care ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Outpatient Basis ◽  
Sudden Increase ◽  
End Organ Damage ◽  
Damage Condition ◽  
Selection Of

The article discusses management tactics for patients with hypertensive crisis – a sudden increase in blood pressure, which is based on the assessment of end-organ damage. In the presence of acute end-organ damage, condition is defined as hypertensive crisis and requires immediate intensive care. In this case, intravenous administration of drug is necessary, the choice of which depends on the type of end-organ damage. Gradual decrease in blood pressure and selection of long-term antihypertensive therapy on an outpatient basis is recommended for patients with hypertensive crisis without acute end-organ damage.

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