scholarly journals Hypertensive emergency and hypertensive urgency management in the emergency department

2021 ◽  
Author(s):  
Erhan ARIKAN
Keyword(s):  
Emergency Department ◽  
Hypertensive Emergency ◽  
Hypertensive Urgency

Abstract T3: Type 2 Myocardial Infarction Predicts Outcome In Hypertensive Crisis Patients: Nationwide Analysis

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Ahmed M Maraey ◽  
Ahmed Elzanaty ◽  
Hadeer R Elsharnoby ◽  
Mahmoud Salem ◽  
Mahmoud Khalil ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Hypertensive Crisis ◽  
Primary Diagnosis ◽  
Hypertensive Emergency ◽  
Secondary Outcome ◽  
Hypertensive Urgency ◽  
Emergency Presentation ◽  
The Impact

Background: Type 2 Myocardial infarction (T2MI) can occur in hypertensive crisis patients. The impact of T2MI in this population is poorly understood due to limited available data. Objective: To assess the impact of T2MI on patients admitted to the hospital with hypertensive crisis. Methods: We queried National Readmission Database (NRD) of year 2018 for adult patients admitted with a primary diagnosis of hypertensive crisis. Patients were excluded if they had type 1 myocardial infarction (T1MI), septic shock, or bleeding in the index admission. Primary outcome was 90-day readmission due to T1MI. Secondary outcome was in-hospital mortality. Subgroup analysis was done according to urgency and emergency presentation. Multivariate regression was done to account for confounders. Results: A total of 101211 patients were included in our cohort of whom 3644 (3.6%) were diagnosed with T2MI and 24471 (24.2%) were readmitted within 90 days of discharge. Of those, 912 (3.7%) were diagnosed with T1MI on readmission. T2MI was independently associated with increased odds of 90-day readmission with T1MI (Adjusted odds ratio (aOR): 2.67, 95% CI [1.91-3.75], P=0.000). T2MI effect was observed in hypertensive urgency, and in hypertensive emergency. T2MI was associated with increased in-hospital mortality in hypertensive urgency population (aOR: 4.21, 95% [1.58-11.25], P=0.004) but not in hypertensive emergency (table 1). Conclusion: In hypertensive crisis patients, T2MI was associated with increased 90-day readmission with T1MI. Aggressive management of cardiovascular risk factors and risk stratification should be considered at the time of diagnosis.

An Emergency Department Approach to Drug Treatment of Hypertensive Urgency and Emergency

2005 ◽  
Vol 18 (5) ◽  
pp. 363-376 ◽  
Author(s):  
Kevin O. Rynn ◽  
Frank L. Hughes ◽  
Brian Faley
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Treatment Options ◽  
Severity Of Illness ◽  
Joint National Committee ◽  
Patient Specific ◽  
National Committee ◽  
Hypertensive Urgency ◽  
Specific Patient ◽  
Hypertensive Urgencies

Patients who present with hypertensive urgency or emergency require immediate attention to assess the severity of illness. Guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are available but do little to address the management of acute elevations in blood pressure. Various treatment options, both old and new, exist to manage these patients in the emergency department. Decisions on therapy are patient specific and depend on the underlying cause of elevated blood pressure. This article sets out to describe specific patient presentations and reviews current available options in the management of hypertensive urgencies and emergencies.

scholarly journals Clinical study of hypertensive crisis at a tertiary care hospital of South India

2018 ◽  
Vol 5 (5) ◽  
pp. 1168
Author(s):  
M. Sai Varun ◽  
Usham Gangaram ◽  
M. V. Nagabushana ◽  
H. G. Revana Siddappa ◽  
Bhimasen Soren
Keyword(s):  
Blood Pressure ◽  
Hypertensive Crisis ◽  
Hypertensive Emergency ◽  
Common Symptom ◽  
Sudden Increase ◽  
Care Hospital ◽  
Hypertensive Urgency ◽  
Adequate Treatment ◽  
Arterial Blood ◽  
Study Results

Background: Hypertensive crisis is a severe clinical condition in which sudden increase in arterial blood pressure can lead to acute vascular damage of vital organs. So timely detection, evaluation and adequate treatment are crucial to prevent permanent damage to vital organs. The aim of the present study is to evaluate incidence and clinical presentation of hypertensive crisis in relation to age, sex, severity of hypertension, accompanying symptoms and clinical manifestations.Methods: It is a clinical prospective study done during the period between January to June 2018 at Narayana Medical College, Nellore. All patients who were more than 18 years with blood pressure>180/120 mmHg to the emergency, outpatients, and inpatients were included. A thorough History and clinical examination was done and necessary investigation was sent to the laboratory.Results: The study results indicate that males (64%) were significantly over represented compared to females (36%). Out of 50 patients majority of the subjects belonged to age group of 50-59 years. Out of 50 Patients most common symptom is Headache (48%), Vomiting (48%), Giddiness (38%), Dyspnoea (22%), Loss of consciousness (22%) followed by chest pain (20%), Blurring of vision (20%) and weakness of limbs (14%). Most of the individuals are in the hypertensive emergency (66%) followed by Hypertensive urgency (34%). Out of 50 patients 56% had neurological involvement and 44% had cardiological involvement. Our study states that most of cases were in grade 1retinopathy (8%) followed in order by grade 4 retinopathy (8%), grade 2 retinopathy (6%) and grade 3 retinopathy (6%).Conclusions: The present study concludes that majority of patients present presenting in hypertensive emergency belonged to fifth and sixth decades of age. So, treating physician should rapidly assess the differentiation of hypertensive emergency and hypertensive urgency in order to prevent end organ damage and to prevent further morbidity and mortality.

scholarly journals Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study

2022 ◽  
Vol 13 (1) ◽  
pp. 66-72
Author(s):  
Navtej Singh ◽  
Tarun ◽  
Ravinder Pal ◽  
Ankit Chamoli
Keyword(s):  
Clinical Presentation ◽  
Target Organ Damage ◽  
Tertiary Care ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Hypertensive Emergency ◽  
Time Interval ◽  
Care Hospital ◽  
Hypertensive Urgency ◽  
Cross Sectional

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.

Pickering syndrome: a rare presentation in emergency department

2021 ◽  
Vol 14 (2) ◽  
pp. e239421
Author(s):  
Prawal Shrimal ◽  
Ankit Kumar Sahu ◽  
Roshan Mathew ◽  
Abhinav Bansal
Keyword(s):  
Emergency Department ◽  
Renal Artery ◽  
Pulmonary Edema ◽  
Young Patient ◽  
Renal Artery Stenosis ◽  
Early Recognition ◽  
Hypertensive Emergency ◽  
Acute Pulmonary Edema ◽  
Rare Presentation ◽  
Life Threatening

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.

scholarly journals Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

2021 ◽  
Vol 11 (1) ◽  
pp. 70
Author(s):  
Mariagiovanna Cantone ◽  
Giuseppe Lanza ◽  
Valentina Puglisi ◽  
Luisa Vinciguerra ◽  
Jaime Mandelli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Hypertensive Crisis ◽  
Intravenous Thrombolysis ◽  
Strong Relationship ◽  
Organ Damage ◽  
Cerebrovascular Diseases ◽  
Narrative Review ◽  
Cerebrovascular Event ◽  
Hypertensive Urgency

Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.

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