Adverse events associated with aggressive treatment of increased blood pressure

Yanturali, Sedat; Akay, Serhat; Ayrık, Cüneyt; Çevik, Arif Alper

doi:10.1111/j.1368-5031.2004.00171.x

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Frequently, antihypertensive drugs are used with the goal of acutely reducing BP in HU, while there is no benefits to support this practice [ 4 , 33 ]. In contrast, there are data on the possible damage from rapid BP reduction in patients without organ damage [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Hypertensive urgencies (HU) and hypertensive emergencies (HE) are challenges for the Emergency Department (ED). A prospective multicentre study is ongoing to characterize patients with acute hypertensive disorders, prevalence of subclinical hypertension-mediated organ damage (HMOD), short- and long-term prognosis; this is a preliminary report. Patients admitted to the ED with symptomatic blood pressure (BP) ≥180/110 mmHg were enrolled. They were managed by ED personnel according to their clinical presentations. Subsequently they underwent clinical evaluation and subclinical HMOD assessment at a Hypertension Centre within 72 h from enrolment. 122 patients were included in this report. Mean age was 60.7±13.9 years, 52.5% were females. 18 (14.8%) patients were diagnosed with HE, 108 (88.5%) with HU. There were no differences in gender, BMI, and cardiovascular comorbidities between groups. At ED discharge, 66.7% and 93.6% ( p = 0.003) of HE and HU patients, respectively, had BP < 180/110 mmHg. After 72 h, 34.4% of patients resulted normotensive; 35.2%, 22.1%, and 8.2% had hypertension grade 1, 2, and 3, respectively. Patients with uncontrolled BP at office evaluation had higher vascular HMOD (49.1 vs. 25.9%, p = 0.045). Cardiac (60 vs. 34%, p = 0.049), renal (27.8 vs. 9.6%, p = 0.010) and cerebral (100 vs. 21%, p < 0.001) HMOD was more frequent in HE compared to HU group. HE showed greater cardiac, renal, and cerebral subclinical HMOD, compared to HU. 72-hours BP control is not associated with different HMOD, except for vascular HMOD; therefore, proper comprehensive examination after discharge from the ED could provide added value in cardiovascular risk stratification of such patients. One third of patients with acute blood pressure rise evaluated to the ED resulted normotensive at office evaluation (<72 hours after discharge). Patients with hypertensive emergency showed greater cardiac, renal, and cerebral subclinical HMOD, compared to the patients with hypertensive urgency. BP: blood pressure; HMOD: hypertension-mediated organ damage; y.o.: years old; mo.: months.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Furthermore, the risks associated with overzealous BP lowering can be devastating. The likelihood of target‐organ ischemia (eg, angina pectoris, myocardial infarction, azotemia, stroke, transient ischemic attack) is most strongly correlated to the rapidity of the BP reduction, even to levels within the hypertensive range, in patients with persistent poor BP control . Thus, the justification for considering a >25% drop in systolic BP within 6 hours of the administration of the IV antihypertensive agent as a potential adverse event, especially because there was only a very small immediate risk for adverse cardiovascular sequelae at the BP levels triggering administration of IV antihypertensive drug therapy.…”

Section: Discussionmentioning

confidence: 99%

As‐needed intravenous antihypertensive therapy and blood pressure control

Lipari

Moser

Petrovitch

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Hospitalized patients with elevated blood pressure (BP) in most cases should be treated with intensification of oral regimens, but are often given intravenous (IV) antihypertensives. OBJECTIVE To determine frequency of prescribing and administering episodic IV antihypertensives and outcomes. DESIGN Retrospective review. SETTING Urban academic hospital. PATIENTS Non–critically ill, hospitalized patients with an IV antihypertensive order for enalaprilat, labetalol, hydralazine, or metoprolol. MEASUREMENTS We analyzed BP thresholds for ordering and administering IV antihypertensives, the types and frequencies of IV antihypertensives administered, and the effect of IV antihypertensive use on short‐term BP and adverse outcomes. The BP change during hospitalization was contrasted in those receiving IV antihypertensives between those who did and did not receive subsequent intensification of chronic oral antihypertensive regimens. RESULTS Two hundred forty‐six patients had an episodic IV antihypertensive order. One hundred seventy‐two patients received 458 doses, with 48% receiving a single dose. Over 98% of episodic IV antihypertensive doses were administered for systolic blood pressure (SBP) <200 mm Hg and 84.5% for SBP <180 mm Hg. Within 6 hours of administration, there was a statistically significant decline in average SBP and diastolic BP in patients receiving IV hydralazine and labetolol. After administration of IV antihypertensives, the oral inpatient medication regimen was adjusted in 52% of patients; these patients had a greater reduction in SBP from admission to discharge than patients with no change to their oral regimens. A total of 32.6% of patients receiving treatment experienced a BP reduction of more than 25% within 6 hours. CONCLUSIONS IV antihypertensive drugs are ordered and administered in patients with asymptomatic, uncontrolled BP for levels unassociated with substantive immediate cardiovascular risk, which may cause adverse effects. Journal of Hospital Medicine 2016;11:193–198. © 2015 Society of Hospital Medicine

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“…Furthermore, mean blood pressure should be diminished between fifteen and twenty-five percent until reaching a systolic pressure of 140 mmHg and a diastolic pressure of 90 mmHg. The objective of gradual reduction of blood pressure within this range is to avoid adverse events [ 19 , 39 , 40 ]. In the present study, the treatment that fulfilled this objective was diltiazem because within 48 hours no patient presented hypertension episodes (compared to 7 patients treated with nifedipine), and fewer subjects had hypotension episodes (3 versus 15 with nifedipine).…”

Section: Discussionmentioning

confidence: 99%

“…Nifedipine has been used as the drug of choice for the treatment of hypertension during puerperium for more than 25 years [ 14 , 17 ]. However, there are several studies that report the presence of serious adverse effects with the use of this drug, such as cerebral ischemia, myocardial ischemia, or tachycardia, as well as episodes of hyper- and hypotension [ 18 , 19 ]. Consequently, it is necessary to find treatment alternatives for these cases.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Diltiazem for the Control of Blood Pressure in Puerperal Patients with Severe Preeclampsia: A Randomized, Single-Blind, Controlled Trial

Arias-Hernández

Vargas‐De‐León

Calzada‐Mendoza

et al. 2020

International Journal of Hypertension

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Background. Postpartum preeclampsia is a serious disease related to high blood pressure that occurs commonly within the first six days after delivery. Objective. To evaluate if diltiazem improves blood pressure parameters in early puerperium patients with severe preeclampsia. Methodology. A randomized, single-blind longitudinal clinical trial of 42 puerperal patients with severe preeclampsia was carried out. Patients were randomized into two groups: the experimental group (n = 21) received diltiazem (60 mg) and the control group (n = 21) received nifedipine (10 mg). Both drugs were orally administered every 8 hours. Systolic, diastolic, and mean blood pressures as well as the heart rate were recorded and analyzed (two-way repeated measures ANOVA) at baseline and after 6, 12, 18, 24, 30, 36, 42, and 48 hours. Primary outcome measures were all the aforementioned blood pressure parameters. Secondary outcome measures included the number of hypertension and hypotension episodes along with the length of stay in the intensive care unit. Results. No statistical differences were found between groups (diltiazem vs. nifedipine) regarding basal blood pressure parameters. Interarm differences in blood pressure (systolic, diastolic, and mean) and heart rate were statistically significant between treatment groups from 6 to 48 hours. Patients in the diltiazem group had lower blood pressure levels than patients in the nifedipine group. Significantly, patients who received diltiazem had fewer hypertension and hypotension episodes and stayed fewer days in the intensive care unit than those treated with nifedipine. Conclusions. Diltiazem controlled arterial hypertension in a more effective and uniform manner in patients under study than nifedipine. Patients treated with diltiazem had fewer collateral effects and spent less time in the hospital. This trial is registered with NCT04222855.

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Adverse events associated with aggressive treatment of increased blood pressure

Cited by 10 publications

References 21 publications

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

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

As‐needed intravenous antihypertensive therapy and blood pressure control

Efficacy of Diltiazem for the Control of Blood Pressure in Puerperal Patients with Severe Preeclampsia: A Randomized, Single-Blind, Controlled Trial

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