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.

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.

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 Hypertensive Crisis in the Elderly Patients

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 128-135
Author(s):  
O. N. Tkacheva ◽  
Yu. V. Kotovskaya ◽  
K. A. Eruslanova
Keyword(s):  
Elderly Patients ◽  
Clinical Symptoms ◽  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
The Elderly ◽  
Organ Damage ◽  
Target Organ ◽  
Sudden Increase ◽  
Chronic Therapy ◽  
High Level

A hypertensive crisis is a sudden increase in blood pressure (BP) to an individually high level associated with clinical symptoms and target organ damage, in which BP must be reduced immediately. Since 2018 in Europe and since 2020 in Russia, an uncomplicated hypertensive crisis is recommended to be considered as a part of malignant (uncontrolled) arterial hypertension. The clinical picture of increased BP in elderly patients is characterized by nonspecific symptoms even in target organ damage. Management of this group of patients requires a physician to know the patient’s comorbidities and the drugs taken on a regular basis to minimize development of side effects of the administered drugs and their undesirable interaction with the chronic therapy.

scholarly journals MOBILISASI PROGRESIF TERHADAP PERUBAHAN TEKANAN DARAH PASIEN DI INTENSIVE CARE UNIT (ICU)

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Ainnur Rahmanti ◽  
Dyah Kartika Putri
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Respiratory Function ◽  
Lateral Position ◽  
High Morbidity ◽  
Left Lateral Position ◽  
Critical Patients

Patient with critical condition had high morbidity and mortality rate. This condition is worsened by long term immobilization. Instability vital sign made nurses stationed delayed mobilization activities in ICU. Progressive mobilization must be started for ICU patient to decrease respiratory function, level of awareness and cardiovascular function. The objective of this study was to identify progressive mobilization activities on blood pressure parameters among critical patients in ICU. The design of this study was quai experiment design. Thirty respondents were included to the study using concequtive sampling. Progressive mobilization was given with head of bed 300 (HOB 300), head of bed450 (HOB 450) with  passive range of motion, continued with right and left lateral position. Anova repeated measurement was used to identify mean difference each of blood pressure. The result of this study show there is two moment sistolic change between HOB 300 to HOB 450 and HOB 450 to right lateral position (3,3%). There is nine moment diastolic change between HOB 450 to right lateral position (16,7%).   Keywords: blood pressure, ICU, Progressive mobilization

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

Circulation ◽  
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

Hypertensive urgencies and emergencies

2010 ◽  
pp. 3074-3082
Author(s):  
Gregory Y.H. Lip ◽  
D. Gareth Beevers
Keyword(s):  
Blood Pressure ◽  
Connective Tissue ◽  
Organ Damage ◽  
Renal Diseases ◽  
Connective Tissue Disorders ◽  
Renovascular Disease ◽  
End Organ Damage ◽  
Hypertensive Emergencies ◽  
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....

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

2019 ◽  
Vol 317 (3) ◽  
pp. F641-F647 ◽  
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.

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

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.

scholarly journals The Effects of Hypertension on Cognitive Function in Children and Adolescents

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Stephen D. Cha ◽  
Hiren P. Patel ◽  
David S. Hains ◽  
John D. Mahan
Keyword(s):  
Children And Adolescents ◽  
Pediatric Population ◽  
Organ Damage ◽  
Future Research ◽  
Cognitive Effects ◽  
Long Term Outcomes ◽  
Future Studies ◽  
End Organ Damage ◽  
Anxiety Depression

Hypertension (HTN) is found in about 3-4% of the pediatric population with long-term risks of end organ damage if untreated or poorly controlled. Although children with HTN are being more frequently screened for end organ damage (i.e., LVH), the cognitive effects of HTN and methods to screen for cognitive dysfunction have not been extensively explored. In recent years, there have been a small number of studies that have provided important insights that can guide future research in this area. These studies show that HTN can be associated with headaches, restlessness, sleep disturbance, anxiety, depression, decreased attention, and also poor executive functioning. By increasing the utilization of cognitive tests in hypertensive children and adolescents, important cognitive defects secondary to HTN may be detected. More research is needed in the area, and the results of future studies could have far reaching implications for long-term outcomes in hypertensive children and adolescents.

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