Haemodynamic changes in emergency department patients with poorly controlled hypertension

Chan, Sun On; Tse, Michael; Chan, Cangel Pui-yee; Tai, Marcus C K; Graham, Colin A.; Rainer, Timothy

doi:10.12809/hkmj154566

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…32,101,103,[107][108][109] In patients with hypertension, SVR was elevated in almost 66% of cases. 117 It was reported that high normal BP (130-139/85-89 mmHg) progresses to…”

Section: Ke9 (Increased Vascular Resistance) To Ao (Hypertension)mentioning

confidence: 99%

“…51,115,116 In patients with hypertension, SVR was elevated in about 66% of enrolled patients. 117 KERs, key event relationships. Rating is high due to extensive and consistent evidence.…”

Section: Highmentioning

confidence: 99%

“…32,101,103,[107][108][109] In patients with hypertension, SVR was elevated in almost 66% of cases. 117 It was reported that high normal BP (130-139/85-89 mmHg) progresses to stage 1 hypertension (>140/>90 mmHg) in 37% of individuals under the age of 64 and in 49% of individuals over the age of 65. In patients with hypertension, the 10-year risk of a cardiovascular-related event (i.e., coronary or cerebrovascular) was 10% in males and 4.4% in females.…”

Section: Moderatementioning

confidence: 99%

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Development of an Adverse Outcome Pathway for the Onset of Hypertension by Oxidative Stress-Mediated Perturbation of Endothelial Nitric Oxide Bioavailability

LoweFrazer¹,

LuettichKarsta²,

TalikkaMarja³

et al. 2017

Applied In Vitro Toxicology

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Hypertension is a cardiovascular risk factor that has a profound influence on cardiovascular morbidity and mortality. While good progress has been made in terms of identifying and managing this risk factor for patient care, methods to assess the potential of chemical compounds to induce hypertension or to assess the efficacy of consumer products (e.g., e-cigarettes) targeted at reducing disease burden remain largely limited to epidemiological associations and in vivo studies. The field of toxicology has undergone a paradigm shift toward the replacement of in vivo testing in toxicological risk assessment. The adverse outcome pathway (AOP) framework could facilitate improved knowledge-based risk/benefit assessment of chemicals or consumer products, respectively, without the necessity of animal testing. Furthermore, to facilitate a more timely, cost effective, and ethical solution for risk/efficacy assessment purposes, integrated testing strategies are required, which do not heavily rely on in vivo studies. In this study, we present the supporting information on an AOP describing how vascular endothelial peptide oxidation leads to hypertension through perturbation of endothelial nitric oxide bioavailability, leading to impaired vasodilation. We also discuss the essentiality of the key events (KEs), and biological plausibility and empirical support of KE relationships, in accordance with the Organisation for Economic Cooperation and Development (OECD) handbook. This AOP could be a useful tool to serve as a foundation for a future integrated testing strategy for the regulatory assessment of the harm reduction potential of e-cigarettes relative to conventional tobacco products and other consumer products, which aim to reduce cardiovascular disease risk.

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“…32,101,103,[107][108][109] In patients with hypertension, SVR was elevated in almost 66% of cases. 117 It was reported that high normal BP (130-139/85-89 mmHg) progresses to…”

Section: Ke9 (Increased Vascular Resistance) To Ao (Hypertension)mentioning

confidence: 99%

“…51,115,116 In patients with hypertension, SVR was elevated in about 66% of enrolled patients. 117 KERs, key event relationships. Rating is high due to extensive and consistent evidence.…”

Section: Highmentioning

confidence: 99%

Section: Moderatementioning

confidence: 99%

See 1 more Smart Citation

Development of an Adverse Outcome Pathway for the Onset of Hypertension by Oxidative Stress-Mediated Perturbation of Endothelial Nitric Oxide Bioavailability

LoweFrazer¹,

LuettichKarsta²,

TalikkaMarja³

et al. 2017

Applied In Vitro Toxicology

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Hypertension in the Emergency Department

2016

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Hypertension is the leading risk factor for the global burden of disease, yet more than 20% of adults with hypertension are unaware of their condition. Underlying hypertension affects over 25% emergency department attendees, and the condition is more commonly encountered in emergency departments than in primary care settings. Emergency departments are strategically well placed to fulfill the important public health goal of screening for hypertension, yet less than 30% of patients with mild to severe hypertension are referred for follow up. In predominantly African American populations, subclinical hypertensive disease is highly prevalent in ED attendees with asymptomatic elevated blood pressure. Although medical intervention is not usually required, in select patient populations, it may be beneficial for antihypertensive medications to be started or adjusted in the emergency department, aiming for optimizing blood pressure control earlier while waiting for continuing care.

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Understanding the Haemodynamics of Hypertension

Smith

Madigan

2018

Curr Hypertens Rep

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Outdated understanding of haemodynamics based on previous measurement systems can no longer be applied to our understanding of the circulation. We question the current view of hypertension as defined by a predominantly systolic blood pressure and introduce the concept of vasogenic, cardiogenic and mixed-origin hypertension. We postulate that failure to identify the individual's haemodynamic pattern may lead to the use of inappropriate medication, which in turn may be a major factor in patient non-compliance with therapeutic strategies. A population-based approach to treatment of hypertension may lead to suboptimal functional dynamics in the individual patient. Finally, we question the validity of current guidelines and published evidence relating morbidity and mortality to the future treatment of hypertension. The importance of individual haemodynamic profiles may be pivotal in the understanding, diagnosis and treatment of hypertension if optimal control with minimal adverse effects is to be achieved. Research based on individual haemodynamic patterns is overdue.

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Haemodynamic changes in emergency department patients with poorly controlled hypertension

Cited by 3 publications

References 13 publications

Development of an Adverse Outcome Pathway for the Onset of Hypertension by Oxidative Stress-Mediated Perturbation of Endothelial Nitric Oxide Bioavailability

Development of an Adverse Outcome Pathway for the Onset of Hypertension by Oxidative Stress-Mediated Perturbation of Endothelial Nitric Oxide Bioavailability

Hypertension in the Emergency Department

Understanding the Haemodynamics of Hypertension

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