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.

scholarly journals A descriptive study on the hypertensive crisis in Visakhapatnam, Andhra Pradesh, India

2020 ◽  
Vol 8 (6) ◽  
pp. 386-391
Author(s):  
Dr. Salla Surya Prakasa Rao ◽  
◽  
Dr. Salla Sweta Ramani ◽  
Dr. Pudi Venkat Sai Kiran ◽  
Dr. Siddanati Kiran Prasad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Andhra Pradesh ◽  
Adverse Outcome ◽  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Descriptive Study ◽  
Organ Damage ◽  
Target Organ ◽  
Elevated Blood ◽  
Presenting Symptoms

Objective: The objective of the present study, A Descriptive study on Hypertensive Crisis inVisakhapatnam, India was to evaluate the modes of presentations, clinical profile, and spectrum oftarget organ damage in patients with hypertensive emergencies. Material and Methods: The studypopulation included patients admitted in this hospital with severely elevated blood pressure withclinical or laboratory evidence of acute target organ damage. Result: The clinical and laboratoryprofile of 50 of these patients were evaluated. Males had higher chances of developing ahypertensive emergency compared to females. The commonest presenting symptoms were chestpain, dyspnoea, and neurological deficit. The majority of the patients have known hypertensives.Higher levels of blood pressure at presentation were associated with an adverse outcome. Acute LVFwas the commonest target organ damage observed. In-hospital mortality of 14% was observed inthe present study. Conclusion: Known hypertensives are at a higher risk of presenting with acutetarget organ damage associated with chest pain. Acute LVF is the commonest form of target organdamage encountered in the present study.

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 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 Characteristics and Predictors of All-Cause Mortality in Patients with Hypertensive Urgency at an Emergency Department

2021 ◽  
Vol 10 (19) ◽  
pp. 4314
Author(s):  
Jeong-Hun Shin ◽  
Byung Sik Kim ◽  
Minhyung Lyu ◽  
Hyun-Jin Kim ◽  
Jun Hyeok Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Emergency Department ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Hypertensive Urgency ◽  
All Cause Mortality ◽  
History Of ◽  
Male Sex

Hypertensive urgency is characterized by an acute increase in blood pressure without acute target organ damage, which is considered to be managed with close outpatient follow-up. However, limited data are available on the prognosis of these cases in emergency departments. We investigated the characteristics and predictors of all-cause mortality in Korean emergency patients with hypertensive urgency. This cross-sectional study included patients aged ≥ 18 years who visited an emergency tertiary referral center between January 2016 and December 2019 for hypertensive urgency, which was defined as a systolic blood pressure of ≥ 180 mmHg and a diastolic blood pressure of ≥ 110 mmHg, or both, without acute target organ damage. The 1 and 3 year all-cause mortality rates were 6.8% and 12.1%, respectively. The incidence of emergency department revisits and readmission after 3 months and 1 year was significantly higher in non-survivors than in survivors. In a multivariate analysis, age ≥ 60 years (hazard ratio (HR), 16.66; 95% CI, 6.20–44.80; p < 0.001), male sex (HR, 1.54; 95% CI, 1.22–1.94; p < 0.001), history of chronic kidney disease (HR, 2.18; 95% CI, 1.53–3.09; p < 0.001), and proteinuria (HR, 1.94; 95% CI, 1.53–2.48; p < 0.001) were independent predictors of 3 year all-cause mortality. The all-cause mortality rate of hypertensive urgency remains high despite the increased utilization of antihypertensive medications. Old age, male sex, history of chronic kidney disease, and proteinuria were poor prognostic factors for all-cause mortality in patients with hypertensive urgency.

scholarly journals Emergency care in a sudden individually significant blood pressure increase without clinically overt target organ damage: rationale for captopril use. Expert Council opinion

2020 ◽  
Vol 25 (2) ◽  
pp. 103-110 ◽  
Author(s):  
S. N. Tereshchenko ◽  
G. P. Arutyunov ◽  
A. S. Galyavich ◽  
N. I. Gaponova ◽  
S. R. Gilyarevsky ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Care ◽  
Enzyme Inhibitor ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Sublingual Administration ◽  
Russian Society ◽  
Hypertensive Urgency ◽  
Duration Of Action

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes. 

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.

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