Hypertensive emergencies in Asia: A brief review

Kotruchin, Praew; Tangpaisarn, Thanat; Mitsungnern, Thapanawong; Sukonthasarn, Apichard; Hoshide, Satoshi; Turana, Yuda; Siddique, Saulat; Buranakitjaroen, Peera; Minh, Huynh Van; Chia, Yook Chin; Park, Sungha; Chen, Chen‐Huan; Nailes, Jennifer; Tay, Jam Chin; Wang, Ji‐Guang; Kario, Kazuomi

doi:10.1111/jch.14547

Cited by 11 publications

(11 citation statements)

References 25 publications

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“…Some differences are at least in part explained by the different HE/HU definitions, in terms of BP cut-off or diagnostic coding; in a large retrospective study, the prevalence of HE in the United States between 2006 and 2013 was lower, probably due to the strict definition, based on acute BP elevation together with a diagnosis of acute organ damage based on the ICD-9 code [ 2 ]. In a recent review, the prevalence of HE in the Asian population ranges from 0.1 to 1.5% [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO

et al. 2023

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Hypertensive urgencies (HU) and hypertensive emergencies (HE) are challenges for the Emergency Department (ED). A prospective multicentre study is ongoing to characterize patients with acute hypertensive disorders, prevalence of subclinical hypertension-mediated organ damage (HMOD), short- and long-term prognosis; this is a preliminary report. Patients admitted to the ED with symptomatic blood pressure (BP) ≥180/110 mmHg were enrolled. They were managed by ED personnel according to their clinical presentations. Subsequently they underwent clinical evaluation and subclinical HMOD assessment at a Hypertension Centre within 72 h from enrolment. 122 patients were included in this report. Mean age was 60.7±13.9 years, 52.5% were females. 18 (14.8%) patients were diagnosed with HE, 108 (88.5%) with HU. There were no differences in gender, BMI, and cardiovascular comorbidities between groups. At ED discharge, 66.7% and 93.6% ( p = 0.003) of HE and HU patients, respectively, had BP < 180/110 mmHg. After 72 h, 34.4% of patients resulted normotensive; 35.2%, 22.1%, and 8.2% had hypertension grade 1, 2, and 3, respectively. Patients with uncontrolled BP at office evaluation had higher vascular HMOD (49.1 vs. 25.9%, p = 0.045). Cardiac (60 vs. 34%, p = 0.049), renal (27.8 vs. 9.6%, p = 0.010) and cerebral (100 vs. 21%, p < 0.001) HMOD was more frequent in HE compared to HU group. HE showed greater cardiac, renal, and cerebral subclinical HMOD, compared to HU. 72-hours BP control is not associated with different HMOD, except for vascular HMOD; therefore, proper comprehensive examination after discharge from the ED could provide added value in cardiovascular risk stratification of such patients. One third of patients with acute blood pressure rise evaluated to the ED resulted normotensive at office evaluation (<72 hours after discharge). Patients with hypertensive emergency showed greater cardiac, renal, and cerebral subclinical HMOD, compared to the patients with hypertensive urgency. BP: blood pressure; HMOD: hypertension-mediated organ damage; y.o.: years old; mo.: months.

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Section: Discussionmentioning

confidence: 99%

Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO

et al. 2023

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“…Additionally, the persistence of arteriolar sclerosis can potentially lead to an increased incidence of arterial or vein occlusions within the eye [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography Findings Associated With Accelerated Hypertension

Mehta

2024

Cureus

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Introduction Accelerated hypertension, that is a systolic blood pressure greater than 180 mmHg and a diastolic blood pressure greater than 120 mmHg is often accompanied by fundoscopic signs with the potential of systemic and visual morbidity. We report on the clinical and optical coherence tomography angiography (OCTA) findings in a cohort of hypertensive patients with accelerated hypertension. Methods Patients, presenting to the emergency room/intensive care unit, who met the clinical definition of accelerated hypertension (a blood pressure >180/120 mmHg,), were triaged to the intensive care unit. Following blood pressure reduction via pharmacological methods, a standard panel of hematological tests, cardiac evaluation tests, and the necessary systemic imaging was performed. They underwent a bedside dilated fundus examination with subsequent fundus photography/OCTA using a Topcon DRI OCT plus (Topcon Corporation, Tokyo, Japan). The records of these patients were evaluated. Results We analyzed the records of 16 patients (12 males (75%), and four females (25%)) with ages ranging from 16 to 75 years (mean 47.6 years). Eleven patients consented to a detailed evaluation. These included nine males (81.8%) and two females (18.1%) with ages ranging from 16 to 63 years (mean 46.3 years). Comorbidities included pre-existing hypertension (nine patients, 81.8%), chronic kidney disease (three patients, 27.2%), and diabetes mellitus type 2 (two patients, 18.1%). Clinical findings in these 22 eyes included arteriolar changes consistent with Keith Wagener Barker (KWB) grade 1 (two eyes, 9.0%), grade 2 (10 eyes, 45.4%), grade 3 (eight eyes, 36.3%), and grade 4 (two eyes, 9.0%). OCTA findings included capillary nonperfusion in the superficial capillary plexus in the areas of retinal opacification (seven eyes, 31.8%). Conclusion OCTA studies of the macular, as well as the entire posterior pole vasculature, may help to detect retinal microangiopathy, permit accurate grading, and subsequently develop a model that permits the quantification of systemic and ocular risk in these patients.

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“…HTN-E is less common, with past studies reporting 0.2-0.8% of total ED evaluations [4,5]. A recent meta-analysis of ED evaluations across Europe, Southeast Asia, and South America found a similar rate of HTN-E, around 0.3% [6,7]. Despite the frequency of elevated BP in the ED meeting criteria, HTN-U is actually only diagnosed in 0.9% of ED discharges, either due to underdiagnosis or spontaneous improvement in ED [6,8].…”

Section: Epidemiologymentioning

confidence: 99%

“…Nitroprusside has been used to treat HTN-E with rapid onset and benefits of simultaneous preload and afterload reduction but has fallen out of favor secondary to cyanide toxicity. It also has the potential for increasing intracerebral edema in neurological emergencies [7]. One recent study found that nitroprusside was still favored by cardiologists over neurologists and emergency medicine physicians, secondary to these hemodynamic effects in the setting of LV dysfunction [26].…”

Section: Medication Selectionmentioning

confidence: 99%

Hypertensive crisis: diagnosis, presentation, and treatment

Stewart¹

2023

Current Opinion in Cardiology

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Purpose of reviewHypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.Recent findingsNovel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130–140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.SummaryHTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.

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Hypertensive emergencies in Asia: A brief review

Cited by 11 publications

References 25 publications

Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO

Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO

Optical Coherence Tomography Angiography Findings Associated With Accelerated Hypertension

Hypertensive crisis: diagnosis, presentation, and treatment

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