Prevalência de verdadeiras crises hipertensivas e adequação da conduta médica em pacientes atendidos em um pronto-socorro geral com pressão arterial elevada

Júnior, Francisco das Chagas Monteiro; Anunciação, Fernando Antônio Costa; Filho, Natalino Salgado; Silva, Genise Mayara Alves da; Barbosa, José Bonifácio; Ferreira, Pedro Antônio Muniz; Lages, Joyce Santos; Mandarino, Natália Ribeiro; Júnior, Wellington Santana da Silva; Monteiro, Carolina Cipriano

doi:10.1590/s0066-782x2008000400006

Cited by 13 publications

(19 citation statements)

References 9 publications

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“…Besides, the records found in the literature regarding patients with hypertensive pseudocrisis are old and scarce. The analysis of the Brazilian literature revealed two studies published over a decade ago that analyzed the clinical management in situations of hypertensive crisis, including pseudocrisis ( 18 ) and the prevalence and clinical characteristics of patients with hypertensive pseudocrisis. ( 19 ) In Brazil, the lack of studies on clinical characteristics of patients, including hypertensive pseudocrisis, emphasizes the importance of our data.…”

Section: Discussionmentioning

confidence: 99%

“…Ainda, os registros encontrados na literatura a respeito de pacientes com pseudocrise hipertensiva são antigos e escassos. A análise da literatura nacional revelou dois estudos publicados há cerca de uma década, que analisaram a conduta médica em situações de crise hipertensiva, incluindo a pseudocrise ( 18 ) e a prevalência e características clínicas de pacientes com pseudocrise hipertensiva. ( 19 ) Portanto, em função da escassez de estudos, em nosso meio, dentre as análises de características clínicas de pacientes, incluindo a pseudocrise hipertensiva, ressalta-se a importância dos nossos dados que, além de inéditos, analisaram simultaneamente a urgência, a emergência e a pseudocrise hipertensiva.…”

Section: Discussionunclassified

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Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department

Pierin

Flórido²,

Santos³

2019

Einstein (São Paulo)

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Objective: To assess patients with hypertensive crisis, classified as urgency, emergency or pseudocrisis, and identify the associated variables. Methods: We evaluated a total of 508 patients (57% women; 56.3±13.8 years old) with hypertensive crisis (diastolic blood pressure of 120mmHg), aged 18 years or over, seen at the emergency department of a public general hospital. Results: The prevalence of hypertensive crises was 6/1,000; in that, 71.7% presented hypertensive urgency, 19.1% hypertensive emergency, and 9.2% hypertensive pseudocrisis. In the multinominal logistic regression, pseudocrisis and urgency conditions were compared to hypertensive emergency. Therefore, the presence of pain (OR: 55.58; 95%CI: 10.55-292.74) except chest pain and headache, and emotional problems (OR: 17.13; 95%CI: 2.80-104.87) increased the likelihood of hypertensive pseudocrisis. Age >60 years (OR: 0,32; 95%CI: 0.10-0.96) and neurologic problems (OR: 1.5.10 -8 ; 95%CI: 1.5.10 -8 -1.5.10 -8 ) protected against hypertensive pseudocrisis. The comparison of hypertensive urgency with hypertensive emergency showed that age >60 years (OR: 0.50; 95%CI: 0.27-0.92), neurologic (OR: 0.09; 95%CI: 0.04-0.18) and emotional problems (OR: 0.06; 95%CI: 4.7.10 -3 -0.79) protected against hypertensive urgency. Moreover, only headache (OR: 14.28; 95%CI: 3.32-61.47) increased the likelihood of hypertensive urgency. Conclusion: Advanced age and neurological problems were associated to hypertensive emergency. Headache was associated with hypertensive urgency. Pain and emotional problems were associated with hypertensive pseudocrisis. Our results can contribute to identifying patients with hypertensive crisis who seek emergency services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department

Pierin

Flórido²,

Santos³

2019

Einstein (São Paulo)

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“…Our study showed a prevalence of hypertensive crisis of 56%. The incidence of hypertensive crisis was 47.22% in a study conducted in Bosnia and 16% in a study conducted in Brazil [ 22 , 23 ]. This indicates that we see more hypertensive crisis compared to the above studies.…”

Section: Discussionmentioning

confidence: 99%

“…Patients admitted with primary diagnosis of hypertension crisis, uncontrolled hypertension, hypertensive emergency, and hypertensive urgency were selected through the ICD-9-CM (I-10: essential (primary) hypertension, I-11: hypertensive heart disease, I-12: hypertensive renal disease, I-13: hypertensive heart and renal disease, and I-15: secondary hypertension). Patients whose medical records did not contain minimal clinical information to allow case classification (hypertensive urgency or emergency) were excluded from the study [ 13 ]. Data over a period of 5 years, from year 2005 till year 2010, was used.…”

Section: Methodsmentioning

confidence: 99%

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

Almas

Ghouse

Iftikhar

et al. 2014

International Journal of Chronic Diseases

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Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

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“…Such attacks constitute true hypertensive emergencies, given that target organs can be severely affected, with the development of cardiac arrhythmias, acute pulmonary edema, myocardial ischemia, or hypertensive encephalopathy, the last of the four eventually giving rise to posterior reversible encephalopathy syndrome (PRES); the pathogenesis of the syndrome is controversial, the white matter in the parietal-occipital regions being most commonly affected 2 , 3. In practice, true hypertensive emergencies, which require immediate blood pressure reduction, should be distinguished from “hypertensive pseudoemergencies”, which are not accompanied by target organ involvement and are often treated inappropriately in emergency rooms 4 - 6…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma-induced shock: a case report

Araújo¹,

Carmo²,

Júnior³

et al. 2012

ACR

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Because of its rarity, together with the variability and nonspecificity of its signs and symptoms, pheochromocytoma, a tumor arising from chromaffin cells, creates an unlucky paradox: it is often missed but only rarely found. Besides the association with arterial hypertension, often in the form of paroxysmal attacks, pheochromocytoma may also be associated, in up to 40% of cases, with orthostatic hypotension which, when present, provides a clue to the diagnosis of the tumor. Far more rare (about 2% of cases) is the clinical presentation in the form of shock, a possibility that, among other attributes, justifies the epithet “the great mimic” applied to the neoplasia. The authors report the case of a 51-year-old hypertensive woman whose death was erroneously attributed to septic shock. Autopsy disclosed an unsuspected left adrenal bulky pheochromocytoma with areas of hemorrhage and extensive central necrosis, pronounced pulmonary edema, left ventricular mural thrombus, and histological evidence of acute myocardial injury.

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Prevalência de verdadeiras crises hipertensivas e adequação da conduta médica em pacientes atendidos em um pronto-socorro geral com pressão arterial elevada

Abstract: SummaryBackground: High blood pressure is a common reason for patients to seek an emergency room, and many of them may possibly be wrongly diagnosed with hypertensive crisis and, consequently, be inappropriately treated.

Cited by 13 publications

References 9 publications

Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department

Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

Pheochromocytoma-induced shock: a case report

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