Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

Abstract

Background: A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders. Methods: Data from 718 patients presenting to the emergency department of the “Città della Salute e della Scienza” Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed. Results: A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity. Conclusion: Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.

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

“…Although we need to increase the sample size to confirm these data, no differences in age, sex and cardiovascular comorbidities are currently present between HE and HU. This seems to disagree with previous findings, in which HE was associated with male sex [ 24 , 27 ], older age, and comorbidities [ 29 ].…”

“…A special consideration should be given to benzodiazepines, class not officially suggested but widely used in clinical practice, as evidenced by previous studies [ 10 , 24 , 29 ]. Administered in almost half of the cases in our cohort, benzodiazepines are definitely recommended medication in adrenergic hyperactivity BP disorders, such as cocaine abuse [ 38 , 43 ], but their use outside this context would merit more in-depth studies.…”

A critical evaluation of risk to reward ratio of quercetin supplementation for COVID‐19 and associated comorbid conditions

“…Nearly 45% of the world's adult population is at risk, particularly the people with an age above 60 years. Although most cases of hypertension are asymptomatic, some may show symptoms of chest pain, pulmonary edema, hypertensive encephalopathy or stroke, and shortness of breath (Vallelonga et al, 2020 ). As observed in previous coronavirus epidemics, such as SARS and MERS, hypertensive patients are at high risk of enhanced mortality with COVID‐19 than non‐hypertensive patients (Nadar, Tayebjee, Stowasser, & Byrd, 2020 ; Pormohammad et al, 2020 ).…”

Hypertensive emergencies crisis and the choice of therapy in prehospital treatments

“…High blood arterial pressure accelerates the process of atherosclerosis in the walls of blood vessels. Narrowed arteries are less able to supply blood to tissues and organs, and over time, their damage and deterioration of their function occur [5]. The formed atherosclerotic plaques in the walls of the vessels burst, as they become inelastic, and a blood clot forms in that place, closing the blood vessel.…”