An Updated Review of Hypertensive Emergencies and Urgencies

Makó, Katalin; Ureche, Corina; Jeremiás, Zsuzsanna

doi:10.2478/jce-2018-0013

Cited by 6 publications

(5 citation statements)

References 59 publications

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“…Reduced production of endothelial vasodilators such as nitric oxide and prostacyclin further elevates blood pressure and exacerbates endothelial damage, a vicious cycle that culminates in enhanced vascular permeability, inhibition of fibrinolysis, platelet aggregation, inflammation, thrombosis, and finally end-organ ischemia 12, 13. (See Figure 1 8, 12-14…”

Section: Pathophysiologymentioning

confidence: 99%

CE: Hypertensive Emergencies: A Review

Sharma

Mathews

Newton

2021

AJN, American Journal of Nursing

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While acute blood pressure elevations are commonly seen in the ED, not all require emergency treatment. True hypertensive emergencies are characterized by a rapid elevation in blood pressure to a level above 180/120 mmHg and are associated with acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy. Recognizing the clinical signs and symptoms of hypertensive emergency, which may vary widely depending on the target organ involved, is critical. High blood pressure levels that produce no signs or symptoms of target organ damage may be treated without hospitalization through an increase in or reestablishment of previously prescribed oral antihypertensive medication. However, all patients presenting with blood pressure this high should undergo evaluation to confirm or rule out impending target organ damage, which differentiates hypertensive emergency from other hypertensive crises and is vital in facilitating appropriate emergency treatment. Drug therapy for hypertensive emergency is influenced by end-organ involvement, pharmacokinetics, potential adverse drug effects, and patient comorbidities. Frequent nursing intervention and close monitoring are crucial to recuperation. Here, the authors define the spectrum of uncontrolled hypertension; discuss the importance of distinguishing hypertensive emergencies from hypertensive urgencies; and describe the pathophysiology, clinical manifestations, and management of hypertensive emergencies.

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Section: Pathophysiologymentioning

confidence: 99%

CE: Hypertensive Emergencies: A Review

Sharma

Mathews

Newton

2021

AJN, American Journal of Nursing

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“…1 Although the optimal target for BP lowering in HE is still uncertain worldwide, personalized treatment is required depending on the nature and magnitude of damage, level of BP elevation, and in particular medication side effects on comorbid conditions. 6,[14][15][16] To safely lower the elevated blood pressure, safeguard target organ function, increase symptoms, decrease complications, and enhance clinical outcomes, patients with HE require the administration of effective and fast-acting intravenous medicines. 4,17 In these patient populations, the recommended intravenous medications and the target BP reduction vary based on the specific end-organ damage.…”

Section: Introductionmentioning

confidence: 99%

In‐hospital outcomes of patients with a hypertensive emergency at a medical center, Ethiopia: A prospective observational study

Yizengaw

Chemeda

Kumela

et al. 2022

Health Science Reports

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Background: Hypertensive emergency is associated with substantial complications and loss of life across the world. Early identification and treatment of hypertensive emergency complications are critical to prevent or avoid any consequences. Despite this, in Ethiopia, studies addressing mortality rate and its predictors as well as complications of hypertensive emergency are limited.Aims: This study aim to evaluate in-hospital mortality of patients admitted with a hypertensive emergency at the emergency ward of Jimma Medical Center.Methods: A consecutive sample of 140 adult (≥18 years of age) patients with a hypertensive emergency were recruited from September 1, 2020 to February 25, 2021 at Jimma Medical Center, Ethiopia and were followed up from admission to discharge/death. Patients who declined to participate and readmitted during the study period were excluded. To assess factors associated with in-hospital mortality, bivariate and multivariate Cox regression analyses were performed. A p value of less than 0.05 was used to declare the statistical significance.Results: Over three-fourths of the study participants, that is, 108 (77.1%), were males with a mean (±standard deviation) age of 52.8 ± 13.6 years. Hemorrhagic stroke, 53 (38.0%), and acute kidney injury, 38 (27.1%), were the most common complications of hypertensive emergency. The average (±standard deviation) length of stay in the hospital was 8.53 ± 3.61 days. During in-hospital follow-up, 16 patients (11.4%, 95% confidence interval: 6.7-17.9) died. Multivariate Cox regression analysis showed that there was a significant relationship between patients not doing regular physical exercise before the current admission (adjusted hazard ratio = 4.629, 95% confidence interval: 1.171-18.294, p = 0.015) and in-hospital mortality.Conclusion: More than one-tenth of patients with hypertensive emergency death was recorded at Jimma Medical Center. The frequent complications of hypertensive emergency were hemorrhagic stroke and acute renal injury. Not doing regular

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“…The structures of the right lateral orbitofrontal lobe, left caudal middle frontal lobe, left superior frontal lobe, left precuneus, and right supramarginal gyrus varied between groups. 12 People with tension-type CPTHA experience mild to moderate bilateral pain with pressing, tugging, and dull quality, worse by exertion, stress, and emotional strain. People with the migraine-type of CPTHA experience severe pounding, throbbing, and stabbing unilateral pain and are made worse by physical activity.…”

Section: Discussionmentioning

confidence: 99%

“…7 Hospital admission and close monitoring in the ICCU is recommended for continuous monitoring of arterial pressure levels, assessment and treatment of target organ damage 1 and administration of intravenous antihypertensive drugs. 12 American College of Cardiology (ACC)/ American Heart Association (AHA) recommends intravenous esmolol, labetalol, nicardipine, or nitroglycerin for a hypertensive emergency with ACS (acute myocardial infarction with or without ST-segment elevation and unstable angina). 12 Similarly, the European Society of Cardiology (ESC)/European Society of Hypertension (ESH) recommends nitroglycerin and labetalol to lower SBP reaching <140 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…12 American College of Cardiology (ACC)/ American Heart Association (AHA) recommends intravenous esmolol, labetalol, nicardipine, or nitroglycerin for a hypertensive emergency with ACS (acute myocardial infarction with or without ST-segment elevation and unstable angina). 12 Similarly, the European Society of Cardiology (ESC)/European Society of Hypertension (ESH) recommends nitroglycerin and labetalol to lower SBP reaching <140 mmHg. 13 Nitroglycerine, a vasodilator that mainly reduces the preload and decreases the cardiac oxygen demands, 7 was used in this patient due to its availability (Table 2).…”

Section: Discussionmentioning

confidence: 99%

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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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An Updated Review of Hypertensive Emergencies and Urgencies

Cited by 6 publications

References 59 publications

CE: Hypertensive Emergencies: A Review

CE: Hypertensive Emergencies: A Review

In‐hospital outcomes of patients with a hypertensive emergency at a medical center, Ethiopia: A prospective observational study

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

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