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.

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 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 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.

Abstract W P250: The Impact of Acute Hypertensive Response on Mortality After Intracerebral Hemorrhage Differs Among Patients With and Without Left Ventricle Hypertrophy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Octavio M Pontes-Neto ◽  
Sergi Martinez-Ramirez ◽  
Anand Viswanathan ◽  
Timothy C Tan ◽  
Maria C Nunes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricle ◽  
Acute Phase ◽  
Blood Pressure Reduction ◽  
Chronic Hypertension ◽  
Pressure Reduction ◽  
Left Ventricle Hypertrophy ◽  
Ventricle Hypertrophy ◽  
Haenszel Test ◽  
Intensive Blood Pressure

Background: While acute hypertensive response (AHR) predicts worse outcome in intracerebral hemorrhage (ICH), the INTERACT-2 trial recently failed to definitively demonstrate a major benefit of intensive blood pressure reduction on these patients. A possible explanation is that the detrimental effect of AHR on outcome may differ among ICH patients with and without previous chronic hypertension. Objective: to explore whether the prognosis of patients with AHR during the acute phase of ICH differs according to the presence or absence of left ventricle hypertrophy (LVH), which is a marker of chronic hypertensive organ damage. Method: we performed a retrospective analysis of a prospective cohort of patients with primary ICH presenting to an academic hospital between January/2000 and December/2012 with age > 18 years, who had a transthoracic echocardiogram available. LVH was defined according to Penn convention. AHR was defined as systolic blood pressure > 180 mmHg on admission. Mantel-Haenszel test was initially used to assess if LVH status influenced the effect of AHR on mortality. For subsequent analyses, ICH patients were divided in 3 groups: without AHR (reference); AHR without LVH; AHR with LVH. A multivariate logistic regression model was then used to identify independent predictors of mortality at 30-days. Results: 430 patients met inclusion criteria. AHR was present in 196 (46.6%), LVH was present in 233 (54.2%); 30-day mortality was 15.6%. On Mantel-Haenszel test, we found a trend (p=0.09) suggesting that absence of LVH increased AHR effect on mortality (OR:1.64; 95% CI: 0.95-2.8; p=0.07). On multivariate analysis, patients with AHR without LVH had significantly higher mortality (OR: 2.65; 95%CI: 1.15 to 6.1; p=0.022) when compared to patients without AHR, after adjusting for baseline characteristics. There was only a trend towards increased mortality in the group of patients with AHR and LVH (OR:2.22; 95% CI: 0.99-5.0; p=0.053). Conclusions: Patients without chronic hypertension appear to be more susceptible to the detrimental effects of AHR during the acute phase of ICH. Stratification of patients with ICH may help to identify those that will have greater benefit with intensive blood pressure reduction in the acute phase of ICH.

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.

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