Acute Treatment of Hypertensive Urgency

Breu, Anthony C.; Axon, R. Neal

doi:10.12788/jhm.3086

Cited by 10 publications

(13 citation statements)

References 31 publications

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“…Whereas prior studies examined proxies for hypotension-related harms, such as hypotension, rapid reduction in BP, tachycardia, or the need to provide IV fluids, our study, to our knowledge, is the first to directly assess end-organ damage, including AKI, myocardial injury, and stroke. Our finding that the harms associated with treatment persist into higher intervals of BP, even those categorized as hypertensive urgency, strengthens the case for conservative management . Moreover, although prior studies have described harms with IV treatment, we included oral and IV agents and analyzed outcomes by route .…”

Section: Discussionmentioning

confidence: 77%

Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions

Rastogi

Sheehan

et al. 2021

JAMA Intern Med

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IMPORTANCE Despite high prevalence of elevated blood pressure (BP) among medical inpatients, BP management guidelines are lacking for this population. The outcomes associated with intensifying BP treatment in the hospital are poorly studied.OBJECTIVES To characterize clinician response to BP in the hospital and at discharge and to compare short-and long-term outcomes associated with antihypertensive treatment intensification.DESIGN, SETTING, AND PARTICIPANTS This cohort study took place from January 1 to December 31, 2017, with 1 year of follow-up at 10 hospitals within the Cleveland Clinic Hospitals health care system. All adults admitted to a medicine service in 2017 were evaluated for inclusion. Patients with cardiovascular diagnoses were excluded. Demographic and BP characteristics were used for propensity matching.EXPOSURES Acute hypertension treatment, defined as administration of an intravenous antihypertensive medication or a new class of an oral antihypertensive treatment. MAIN OUTCOMES AND MEASURESThe association between acute hypertension treatment and subsequent inpatient acute kidney injury, myocardial injury, and stroke was measured. Postdischarge outcomes included stroke and myocardial infarction within 30 days and BP control up to 1 year. RESULTS Among 22 834 adults hospitalized for noncardiovascular diagnoses (mean [SD] age, 65.6 [17.9] years; 12 993 women [56.9%]; 15 963 White patients [69.9%]), 17 821 (78%) had at least 1 hypertensive BP recorded during their admission. Of these patients, 5904 (33.1%) were treated. A total of 8692 of 106 097 cases (8.2%) of hypertensive systolic BPs were treated; of these, 5747 (66%) were treated with oral medications. In a propensity-matched sample controlling for patient and BP characteristics, treated patients had higher rates of subsequent acute kidney injury (466 of 4520 [10.3%] vs 357 of 4520 [7.9%]; P < .001) and myocardial injury (53 of 4520 [1.2%] vs 26 of 4520 [0.6%]; P = .003). There was no BP interval in which treated patients had better outcomes than untreated patients. A total of 1645 of 17 821 patients (9%) with hypertension were discharged with an intensified antihypertensive regimen. Medication intensification at discharge was not associated with better BP control in the following year. CONCLUSIONS AND RELEVANCEIn this cohort study, hypertension was common among medical inpatients, but antihypertensive treatment intensification was not. Intensification of therapy without signs of end-organ damage was associated with worse outcomes.

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Section: Discussionmentioning

confidence: 77%

Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions

Rastogi

Sheehan

et al. 2021

JAMA Intern Med

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“…The patient’s target BP should not be set at a level much lower than the baseline BP [ 1 ]. In real-world practice, treatment of HTN-U has varied, ranging from prescribing medications for treating potential secondary causes such as pain or drug withdrawal to resting for at least 30 minutes [ 7 ]. A study found that among 379 patients who presented to the clinic with HTN-U, those referred to the ED and those sent home had similar rates of major adverse cardiovascular events [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…6 The in-hospital and one-year mortality for a hypertensive emergency are 13% and 39%, respectively. 17 These data demonstrate that hypertensive emergencies have both short-and long-term risks. 17 limits.…”

Section: Discussionmentioning

confidence: 83%

Non-ST Elevation Acute Coronary Syndrome (NSTEACS) as Hypertension-Mediated Organ Damage (HMOD) in Hypertensive Emergencies

Puspaseruni¹,

Rizka²,

Sakulat³

2023

Cermin Dunia Kedokteran

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Hypertensive emergencies are characterized by severe increases in blood pressure with evidence of hypertension-mediated organ damage (HMOD) and are associated with an increased risk of cardiovascular events, i.e. coronary heart disease (CHD) and mortality. Case: A 75-year-old man with typical chest pain with nausea and vomiting 1 hour before admission. Blood pressure was 200/100 mmHg, ECG showed T inversion in leads II, III, AVF, V1-V6 and prolonged QT interval, cardiomegaly on chest x-ray, and leukocytosis, hyperglycemia, and hypokalemia. The diagnoses were non-ST elevation acute coronary syndrome (NSTE-ACS), hypertensive emergency, and T2DM. Treatment in the ICCU consists of intravenous antihypertensive, antiplatelet, anticoagulant, statin, nitrate, insulin, and potassium chloride for electrolyte correction. The patient was admitted to the ICCU for further observation and management. Hipertensi emergensi ditandai dengan kenaikan tekanan darah yang sangat disertai bukti kerusakan organ yang progresif (hypertension-mediated organ damage - HMOD). Keadaan ini berkaitan dengan peningkatan risiko kejadian penyakit kardiovaskular, seperti penyakit jantung koroner bahkan kematian. Kasus: Seorang laki-laki usia 75 tahun dengan nyeri dada tipikal sejak 1 jam sebelum datang ke rumah sakit disertai mual dan muntah. Tekanan darah 200/100 mmHg, pada EKG didapatkan inversi T pada lead II, III, AVF, V1-V6, dan pemanjangan interval QT. Pada pemeriksaan X-ray dada didapatkan kardiomegali, hasil laboratorium menunjukkan leukositosis, hiperglikemi, dan hipokalemi. Pasien didiagnosis non-ST elevation acute coronary syndrome (NSTE-ACS), hipertensi emergensi, dan diabetes melitus tipe 2. Tata laksana di ICCU menggunakan anti-hipertensi intravena, anti-platelet, anti-koagulan, statin, nitrat, insulin, dan kalium klorida untuk koreksi elektrolit. Pasien dirawat di ICCU untuk observasi dan tata laksana lebih lanjut.

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Acute Treatment of Hypertensive Urgency

Cited by 10 publications

References 31 publications

Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions

Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions

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

Non-ST Elevation Acute Coronary Syndrome (NSTEACS) as Hypertension-Mediated Organ Damage (HMOD) in Hypertensive Emergencies

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