Cardiovascular Hypertensive Emergencies

Abstract

Inevitably, a small proportion of patients with systematic hypertension will develop hypertensive crisis at some point. Hypertensive crises can be divided into hypertensive emergency or hypertensive urgency according to the presence or lack of acute target organ damage. In this review, we discuss cardiovascular hypertensive emergencies, including acute coronary syndrome, aortic dissection, congestive heart failure, and sympathomimetic hypertensive crises, including those caused by cocaine use. Each presents in a unique fashion, although some hypertensive emergency patients report nonspecific symptoms. Treatment includes several effective and rapid-acting medications to safely reduce the blood pressure, protect remaining end-organ function, relieve symptoms, minimize the risk of complications, and thereby improve patient outcomes.

Modern management of hypertensive emergencies and urgencies: Do we need more technology, paramedics, or physicians?

“…This can be done only after carefully assessing the available information by registries (as the one currently organized by the European Society of Hypertension), and studies comparing different drug approaches should take place. Unfortunately, there are scarce data on the latter, making our therapies based on experience and pathophysiology rather than on findings from solid randomized well‐powered studies …”

“…Unfortunately, there are scarce data on the latter, making our therapies based on experience and pathophysiology rather than on findings from solid randomized well-powered studies. [4][5][6][7][8][9] The study suggests that adherence to guidelines and protocols regarding treatment of hypertensive urgencies and emergencies ensures safety and efficacy and this could be better performed through consultation with a displayed proposed algorithm by the tele-EMS physician, whereas the on-site doctor was provided only a booklet. 1 This could result in differences in the anamnestic and documentation quality, as well as the time spent by the physician in each case, but the correlation with better long-term outcome, if any, is not shown in this report.…”

“…1 Finding the best therapy for hypertensive urgencies and emergencies, which develop in approximately 1% to 2% of patients with hypertension, remains a challenge. [5][6][7][8] Presence of target organ damage sets the stage for an unfavorable cardiovascular prognosis, with the most common emergencies associated with severely elevated blood pressure including acute left ventricular dysfunction with pulmonary edema, acute coronary syndromes, aortic dissection, renal dysfunction, and stroke. [5][6][7][8] By recognizing these cases and providing adequate and timely antihypertensive therapy, long-term mortality rates of patients with hypertensive emergencies have decreased significantly from 80% in 1928 to <10% at present.…”

“…[5][6][7][8] Presence of target organ damage sets the stage for an unfavorable cardiovascular prognosis, with the most common emergencies associated with severely elevated blood pressure including acute left ventricular dysfunction with pulmonary edema, acute coronary syndromes, aortic dissection, renal dysfunction, and stroke. [5][6][7][8] By recognizing these cases and providing adequate and timely antihypertensive therapy, long-term mortality rates of patients with hypertensive emergencies have decreased significantly from 80% in 1928 to <10% at present. [5][6][7][8] An important issue is that current guidelines do not provide enough evidence for the appropriate steps of therapy in cases of hypertensive urgencies and emergencies and there are diverse protocols not only in each country but also in each hospital and institution.…”

“…[5][6][7][8] By recognizing these cases and providing adequate and timely antihypertensive therapy, long-term mortality rates of patients with hypertensive emergencies have decreased significantly from 80% in 1928 to <10% at present. [5][6][7][8] An important issue is that current guidelines do not provide enough evidence for the appropriate steps of therapy in cases of hypertensive urgencies and emergencies and there are diverse protocols not only in each country but also in each hospital and institution. 1,4,8 In their study, a specific protocol is followed by the paramedics in conjunction with teleconsultation, but its validity has not been tested and is more like an expert consensus on the clinical problem of hypertensive urgencies and emergencies.…”