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

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.

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

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.

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 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.

An Emergency Department Approach to Drug Treatment of Hypertensive Urgency and Emergency

2005 ◽  
Vol 18 (5) ◽  
pp. 363-376 ◽  
Author(s):  
Kevin O. Rynn ◽  
Frank L. Hughes ◽  
Brian Faley
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Treatment Options ◽  
Severity Of Illness ◽  
Joint National Committee ◽  
Patient Specific ◽  
National Committee ◽  
Hypertensive Urgency ◽  
Specific Patient ◽  
Hypertensive Urgencies

Patients who present with hypertensive urgency or emergency require immediate attention to assess the severity of illness. Guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are available but do little to address the management of acute elevations in blood pressure. Various treatment options, both old and new, exist to manage these patients in the emergency department. Decisions on therapy are patient specific and depend on the underlying cause of elevated blood pressure. This article sets out to describe specific patient presentations and reviews current available options in the management of hypertensive urgencies and emergencies.

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 Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0251311
Author(s):  
Yu-Ting Lin ◽  
Yen-Hung Liu ◽  
Ya-Luan Hsiao ◽  
Hsiu-Yin Chiang ◽  
Pei-Shan Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Emergency Department ◽  
Cardiovascular Mortality ◽  
Wide Spectrum ◽  
Hypertensive Crisis ◽  
Cox Proportional Hazards ◽  
Pharmacological Intervention ◽  
Care Utilization

Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.

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.

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.

Der hypertensive Notfall

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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