Recent Advances in the Treatment of Hypertensive Emergencies

2010 ◽  
Vol 30 (5) ◽  
pp. 24-30 ◽  
Author(s):  
Pamela L. Smithburger ◽  
Sandra L. Kane-Gill ◽  
Breanne L. Nestor ◽  
Amy L. Seybert
Keyword(s):  
Hypertensive Crisis ◽  
Acute Hypertension ◽  
Hypertensive Emergencies ◽  
Recent Advances ◽  
Hypertensive Urgencies

This review defines hypertensive crisis, hypertensive urgencies, and hypertensive emergencies, and provides recent updates on the management of acute hypertension.

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 Caracterización de las Crisis Hipertensivas en adultos de la Emergencia del Hospital José Félix Valdivieso, Enero 2016 a Diciembre 2018

2020 ◽  
Vol 12 (2) ◽  
pp. 119-124
Author(s):  
Braulio Saavedra Flores ◽  
Andrea Catalina Ochoa Bravo ◽  
Gabriel Aníbal Hugo Merino ◽  
Cristina Fernanda Iñiguez Chacha ◽  
Juan Fernando Gálvez Vallejo ◽  
...  
Keyword(s):  
Rural Areas ◽  
Initial Treatment ◽  
Hypertensive Crisis ◽  
Cross Sectional ◽  
Hypertensive Emergencies ◽  
Previous Diagnosis ◽  
Hypertensive Urgencies ◽  
Epidemiological Characteristics ◽  
The Brain ◽  
Diagnosis Of Hypertension

BACKGROUND: Hypertensive crisis is considered an acute complication of Hypertension, causing 9.4 million deaths annually. Another important problem is the resulting morbidity. Locally, data is limited, that is the importance of presenting the clinical and epidemiological characteristics of hypertensive crisis. The aim of this study was characterizing hypertensive crisis in adults, in Hospital José Félix Valdivieso, Santa Isabel, from January 2016 to December 2018. METHODS: Descriptive, cross-sectional study, the study universe were 151 patients diagnosed with hypertensive crisis in Hospital José Félix Valdivieso from January 2016 to December 2018, by simple random sampling we picked 122 patients. The information was obtained from the patient’s medical chart. The data was processed using Excel 2016, and later interpreted using tables and charts. RESULTS: 57% of the sample were female, 49% had between 40 to 65 years of age, 67% had primary education, 65% came from rural areas. About risk factors; 50% of the population was overweight, 70% had previous diagnosis of hypertension. About the type of hypertensive crisis; 93% were hypertensive urgencies, the most commonly affected organ in hypertensive emergencies was the brain, in 89% of the cases. Headache, was the most frequent symptom(59%), followed by neurological symptoms. Captopril was used as initial treatment in 61% of the cases. CONCLUSION: The majority of affected patients were female, middle aged adults. Most of the sample had overweight or obesity. 70% of the population had previous diagnosis of hypertension, of this patients only 80% had hypertensive treatment. Most of the crisis were hypertensive urgencies, in hypertensive emergencies the most commonly affect organ was the brain. Captopril was used in most of the cases for initial treatment. This study didn’t registered any deaths.

Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives

2018 ◽  
Vol 31 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Alex Cobb ◽  
Luciana Thornton
Keyword(s):  
Sodium Nitroprusside ◽  
Hypertensive Crisis ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Similar Efficacy ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Channel Blockers ◽  
Acute Hypertension ◽  
Therapeutic Interchange

Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as US$900 per vial, earning the drug its status as a “hyperinflation drug.” Hyperinflation drugs pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective cost containment strategy. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy to address rising drug costs. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

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 Malignant hypertension and hypertensive emergencies.

1998 ◽  
Vol 9 (1) ◽  
pp. 133-142 ◽  
Author(s):  
C Kitiyakara ◽  
N J Guzman
Keyword(s):  
Damage Control ◽  
Organ Damage ◽  
Endothelial Damage ◽  
Target Organ ◽  
Malignant Hypertension ◽  
Organ Function ◽  
Hypertensive Urgency ◽  
Hypertensive Emergencies ◽  
Oral Agents ◽  
Hypertensive Urgencies

Hypertensive emergencies and urgencies are important causes of morbidity and mortality. Malignant hypertension is a hypertensive urgency characterized by grade III/IV retinopathy and widespread endothelial damage. Control of BP is essential in the treatment of these disorders. The effects of hypertension on target organ function need to be balanced against the risks of excessive BP lowering. In hypertensive emergencies, BP should be lowered within minutes with parenteral agents to prevent critical end-organ damage. In hypertensive urgencies, BP can be lowered more slowly over several hours, often with oral agents, to avoid a detrimental fall in BP. The absolute indications for treatment and the optimal therapy depend on the underlying condition.

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

2018 ◽  
Vol 5 (1) ◽  
pp. 37-46 ◽  
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.

Hypertensive Crisis: Hypertensive Emergencies and Urgencies

2006 ◽  
Vol 24 (1) ◽  
pp. 135-146 ◽  
Author(s):  
Monica Aggarwal ◽  
Ijaz A. Khan
Keyword(s):  
Hypertensive Crisis ◽  
Hypertensive Emergencies

Pheochromocytoma Unmasked by Amisulpride and Tiapride

2005 ◽  
Vol 39 (5) ◽  
pp. 970-972 ◽  
Author(s):  
Agnès Henry ◽  
Bruno Charpiat ◽  
Thierry Vial ◽  
Serge Franchini ◽  
François J Cuilleret ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Hypertensive Crisis ◽  
Abdominal Ultrasound ◽  
Underlying Mechanism ◽  
Severe Headache ◽  
Probability Scale ◽  
Drug Induced ◽  
Acute Hypertension ◽  
Case Summary ◽  
Substituted Benzamide

OBJECTIVE: To describe the unmasking of pheochromocytoma in a patient treated with amisulpride and tiapride. CASE SUMMARY: A 42-year-old white man developed acute hypertension with severe headache and vomiting 2 hours after the first doses of amisulpride 100 mg and tiapride 100 mg. Both drugs were immediately discontinued, and the patient recovered after subsequent nicardipine and verapamil treatment. Abdominal ultrasound showed an adrenal mass, and postoperative histologic examination confirmed the diagnosis of pheochromocytoma. DISCUSSION: Drug-induced symptoms of pheochromocytoma are often associated with the use of substituted benzamide drugs, but the underlying mechanism is unknown. In our case, use of the Naranjo probability scale indicated a possible relationship between the hypertensive crisis and amisulpride and tiapride therapy. CONCLUSIONS: As of March 24, 2005, this is the first reported case of amisulpride- and tiapride-induced hypertensive crisis in a patient with pheochromocytoma. Physicians and other healthcare professionals should be aware of this potential adverse effect of tiapride and amisulpride.

scholarly journals Modern Management of Hypertensive Emergencies

2019 ◽  
Vol 5 (4) ◽  
pp. 126-130
Author(s):  
Monica Marton-Popovici
Keyword(s):  
Blood Pressure ◽  
Management Strategy ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Hypertensive Encephalopathy ◽  
Target Organ ◽  
Critical Conditions ◽  
Acute Hypertension ◽  
Acute Cardiogenic Pulmonary Edema ◽  
Hypertensive Emergencies

Abstract Hypertensive emergencies (HE) represent critical conditions in which extremely high blood pressure values are accompanied by acute hypertension-mediated organ damage. In this clinical setting, the main therapeutic goal is represented by the immediate reduction of blood pressure, in order to limit the extension or promote the regression of target organ damage. At present, HE are classified according to the condition or target organ involved, into: (1) malignant hypertension with or without thrombotic microangiopathy; (2) coronary ischemia or acute cardiogenic pulmonary edema; (3) acute stroke or hypertensive encephalopathy; (4) acute aortic dissection or aneurysm; and (5) eclampsia or severe preeclampsia/HELLP syndrome. The management of these conditions is different in relation to the complex pathophysiology involved in each of these types. This mini-review presents the main characteristics and management strategy for different forms of HE, revealing the particularities of management strategy for each of them.

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