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Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
For hypertensive urgency, a 2-drug oral antihypertensive combination is administered and the patient is closely evaluated for a response. This continues on an outpatient basis. Hypertensive urgency often occurs in patients that have not slept well for a few weeks, or in those that are extremely anxious.
Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
While nonpregnant patients with hypertensive crisis most commonly present to emergency care with symptoms related to target-organ involvement, this may not be true for pregnant patients, who have many interactions with the health-care system during pregnancy. The pregnant patient with hyper-tensive crisis (e.g., hypertensive urgency rather than emergency) may be asymptomatic and be admitted for evaluation after hypertension is noted in the office. As a rule, the patient with abnormally high blood pressure but no signs or symptoms of target-organ damage is considered to have a hypertensive urgency rather than emergency. Unlike true hypertensive emergency, hypertensive urgency allows 24 to 48 hours to normalize blood pressure: oral agents are acceptable. It is prudent to lower mean arterial pressure gradually so that the limits of autoregulation are not exceeded.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
A hypertensive emergency exists when there is organ damage, or impending organ damage, and is not defined in terms of the BP level, as this in itself cannot predict the severity of the problem alone [5,6]. The term hypertensive “urgency” is sometimes used [7,8] to distinguish those cases without organ damage, but with a possibility of such damage occurring in the next day or so. In practice this exact distinction is not often possible. The organs susceptible to damage include the brain, eyes, heart and kidney, with the major pathological process being fibrinoid necrosis of arterioles.
Clinical implications of cardiac troponin-I in patients with hypertensive crisis visiting the emergency department
Published in Annals of Medicine, 2022
Woohyeun Kim, Byung Sik Kim, Hyun-Jin Kim, Jun Hyeok Lee, Jinho Shin, Jeong-Hun Shin
In this observational study, we analysed a total of 172,105 patients who visited the ED of Hanyang University Guri Hospital from January 2016 to December 2019. Among 10,083 patients with an initial triage systolic BP ≥ 180 mmHg and/or diastolic BP ≥ 110 mmHg, patients under 18 years of age, those with acute trauma and those who visited for certificate issuance were excluded. Only data from the first visit were included in patients with multiple visits to the ED. Among the 6467 patients with hypertensive crisis, 3938 who underwent cTnI assays were analysed (Figure 1). Patients with hypertensive crisis were further divided into hypertensive emergency and hypertensive urgency according to the presence or absence of acute HMOD. Acute HMOD was defined by the presence of one of the following conditions: hypertensive encephalopathy, cerebral infarction, intracerebral haemorrhage, retinopathy, acute heart failure, acute coronary syndrome, acute renal failure and aortic dissection [8].
The determinants of neurological phenotypes during acute hypertensive crises – a preliminary study
Published in Neurological Research, 2020
Mehmet Yasir Pektezel, Mehmet Akif Topcuoglu, Rahsan Gocmen, Bulent Erbil, Mehmet Mahir Kunt, Nalan Metin Aksu, Kader Karli Oguz, Ethem Murat Arsava
Hypertension affects more than one-third of the adult population and is the leading risk factor contributing to the global disease burden [1,2]. On top of the wide spectrum of morbidities related to end-organ damage associated with chronic hypertension, less than 1% of hypertensive people experience acute and severe surges in blood pressure necessitating acute medical intervention [3]. These hypertensive crises are categorized as hypertensive urgency or emergency based on the absence or presence of acute end-organ damage, respectively [4]. From the neurology perspective, these crises might remain asymptomatic at one extreme, while on the other hand they could culminate in a variety of clinico-radiologic scenarios ranging from mild encephalopathy to catastrophic intracerebral bleeding.
Hypertensive emergencies in diabetic patients from predominantly African American urban communities
Published in Clinical and Experimental Hypertension, 2019
Irina Benenson, Frederick Andrew Waldron, Shelly A. Jones Dillon, Shreni N. Zinzuwadia, Nkehci Mbadugha, Natali Vicente, Ela Aris, Adedamola M. Adeboye, Christine Makdisi
Hypertensive crisis (HC) is the most extreme form of poorly controlled HTN. Based on 2017 American College of Cardiology and American Heart Association guidelines, HC is defined as an acute elevation of BP ≥ 180/120 mmHg (7). Hypertensive crisis may present as a hypertensive urgency (HTN-U) or a hypertensive emergency (HTN-E) (7). HTN-E is described as an acute increase in BP ≥ 180/120 mmHg associated with potentially life-threatening target organ damage (7) such as cerebrovascular or cardiovascular events, acute renal injury and aortic dissection (8). For this condition, hospitalization and intravenous antihypertensive medications are required for prompt BP control. It is currently estimated that 1–2% of patients with HTN will have a HTN-E at some point in their lifetime (9). Diabetes patients are more likely to develop HTN-E (10–12) and experience more fatal and non-fatal target organ injuries than non-diabetic patients (13). Hypertensive urgency, on the contrary, is characterized by an acute rise in BP ≥ 180/120 mmHg in the absence of acute target organ damage (7). Given benign short-term outcomes, this condition can be effectively managed with a close outpatient follow-up. Though current guidelines label HC as an elevation of BP ≥ 180/120 mmHg (7), evidence regarding levels of BP for the definition of hypertensive crisis is inconclusive, as the same degree of BP increase may translate into life-threatening target organ injuries in one patient or may result in no symptoms in another patient (8). On the other hand, in some patients, BP below 180/120 mmHg threshold may cause significant damage to vital organs (14).