Impending hypertensive emergency is frequently considered in guidelines, but neither defined nor explained

Koraćević, Goran; Stojanović, Milovan; Lović, Dragan; Djordjević, Dragan

doi:10.1080/08037051.2020.1769467

Blood Pressure

2020

DOI: 10.1080/08037051.2020.1769467

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Impending hypertensive emergency is frequently considered in guidelines, but neither defined nor explained

Goran Koraćević

Milovan Stojanović²,

Dragan Lović

et al.

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Cited by 3 publications

References 5 publications

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Proposal of a Modified Classification of Hypertensive Crises: Urgency, Impending Emergency, and Emergency

Koracevic,

Stojanovic,

Zdravkovic

et al. 2024

CVP

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Systemic arterial hypertension (HTN) is the main cause of morbidity and mortality, and HTN crises contribute significantly to an unfavourable clinical course. For decades, HTN crises have been dichotomized into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). The main difference between the two is the presence of acute hypertension-mediated organ damage (HMOD) – if HMOD is present, HTN crisis is HTN-E; if not, it is HTN-U. Patients with HTN-E are in a life-threatening situation. They are hospitalized and receive antihypertensive drugs intravenously (IV). On the other hand, patients with HTN-U are usually not hospitalized and receive their antihypertensives orally. We suggest a modification of the current risk stratification scheme for patients with HTN crises. The new category would be the intermediate risk group, more precisely the ‘impending HTN-E’ group, with a higher risk in comparison to HTN-U and a lower risk than HTN-E. ‘Impending HMOD’ means that HMOD has not occurred (yet), and the prognosis is, therefore, better than in patients with ongoing HMOD. There are three main reasons to classify patients as having impending HTN-E: excessively elevated BP, high-risk comorbidities, and ongoing bleeding/high bleeding risk. Their combinations are probable. This approach may enable us to prevent some HTNEs by avoiding acute HMOD using a timely blood pressure treatment. This treatment should be prompt but controlled.

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Proposal of a Modified Classification of Hypertensive Crises: Urgency, Impending Emergency, and Emergency

Koracevic,

Stojanovic,

Zdravkovic

et al. 2024

CVP

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Rationale for the Concept of Impending Hypertension-Mediated Organ Damage

Koraćević

Stojanović²,

Lović

et al. 2022

CVP

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Background: The number of patients with hypertension urgencies (HTN-Us) and emergencies (HTN-Es) in the emergency department is relatively constant despite improved detection, awareness and control of arterial hypertension. Objective: This study analyses the precision of the often-used definition of HTN-E, particularly the phrase ‘with the evidence of impending or progressive hypertension-mediated organ damage (HMOD)’. We then provide a rationale for the concept of impending HMOD. MethodS: We searched PubMed, Science Direct, Springer, Oxford Press, Wiley, SAGE and Google Scholar and analysed the relevant definition. Results: The definition of HTN-E is suboptimal and requires a consensus on whether to include the phrase ‘impending hypertensive HMOD’ in the definition. Conclusion: A consensus on the principles of treating the ‘impending hypertensive HMOD’ does not exist, making its use inconsistent in emergency departments worldwide. In this paper, we present a rationale for the concept of ‘impending HMOD’.

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Blood pressure cut-offs to diagnose impending hypertensive emergency depend on previous hypertension-mediated organ damage and comorbid conditions

KORACEVIC,

STOJANOVIC,

LOVIC

et al. 2024

NMJI

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Background Hypertensive emergencies (HTN-E) are important due to a high risk of mortality. However, a sudden increase in blood pressure (BP) can damage target organs before the BP reaches cut-offs to diagnose HTN-E. We (i) analyse HTN guidelines for recommendations of treatment individualization, such as adjusting BP cut-offs for hypertensive urgency or impending HTN-E according to patient’s susceptibility to complications (because of previous hypertension-mediated organ damage [HMOD], cardiovascular events and comorbid conditions), and (ii) provide a rationale for the inclusion of patient’s susceptibility in protocols for treatment of acute HTN-E. Methods We searched PubMed, SCOPUS, Science Direct, Springer, Oxford Press, Wiley, SAGE and Google Scholar for the following terms: arterial hypertension, impending, emergency, target organ damage, hypertension-mediated organ damage, and comorbidity. Results The available guidelines do not recommend that when we estimate the probability of HTN-E in a patient with very high BP, we take into account not only the ‘aggressive factor’ (i.e. history of HTN, absolute BP values and rate of its increase), but also the ‘vulnerability of the patient’ due to previous major adverse cardio-vascular events, HMOD and comorbid conditions. Conclusion The risk does not depend only on the aggressiveness of the health threat but also on the strength of the host’s defence. It is, therefore, surprising that one side of the natural interaction (i.e. susceptibility of a patient) is overlooked in almost all available guidelines on HTN.

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Impending hypertensive emergency is frequently considered in guidelines, but neither defined nor explained

Cited by 3 publications

References 5 publications

Proposal of a Modified Classification of Hypertensive Crises: Urgency, Impending Emergency, and Emergency

Proposal of a Modified Classification of Hypertensive Crises: Urgency, Impending Emergency, and Emergency

Rationale for the Concept of Impending Hypertension-Mediated Organ Damage

Blood pressure cut-offs to diagnose impending hypertensive emergency depend on previous hypertension-mediated organ damage and comorbid conditions

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