Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort

Levy, Phillip D.; Mahn, James J.; Miller, Joseph; Shelby, Alicia; Brody, Aaron; Davidson, Russell; Burla, Michael J.; Marinica, Alexander L.; Carroll, Justin A.; Purakal, John; Flack, John M.; Welch, Robert D.

doi:10.1016/j.ajem.2015.05.036

Cited by 56 publications

(26 citation statements)

References 20 publications

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“…Despite the common occurrence of hypertensive crisis, the evidence regarding assessment of biomarkers in situations of acute hypertensive TOD is scarce. Studies have shown that asymptomatic individuals with markedly elevated BP without TOD do not benefit from acute reduction of BP [40,41]. Thus, it is important to find a marker that can be used to increase diagnostic accuracy in this population, especially in the HypEmerg, or in those with suspicious clinical findings that require confirmation.…”

Section: Discussionmentioning

confidence: 99%

Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis

Valente

Andrade

Cosenso-Martin

et al. 2020

BMC Cardiovasc Disord

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Background: Matrix metalloproteinase-9 (MMP-9) participates in the degradation of components of the extracellular matrix and it is involved in vascular remodeling and vasomotor changes. The aim of this study was to investigate the plasma levels of MMP-9 in acute vascular alterations due to hypertensive crisis. Methods: This cross-sectional study was performed in 40 normotensive (NT) and 58 controlled hypertensive subjects (CHyp) followed up in outpatient clinic. Moreover, 57 patients with hypertensive emergency (HypEmerg) and 43 in hypertensive urgency (HypUrg), seen in emergency department, were also included. Hypertensive crisis was divided into HypEmerg, which was characterized by levels of systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg complicated with target-organ damage (TOD), and HypUrg, defined by BP elevation without TOD. Univariate and multivariate regression analysis was performed to identify the influence of independent variables on MMP-9 levels. A p-value < 0.05 was considered statistically significant. Results: The mean age was 43.5 years in the NT group (11 men); 57.7 years in the CHyp group (29 men); 59.4 years in the HypUrg group (21 men) and 62.4 years in the HypEmerg group (31 men). The age was statistically different in the NT group compared to other 3 groups. The mean BP was 116.5 ± 13.9/72.4 ± 10.6 mmHg for NT, 123.2 ± 12.6/79 ± 9.2 for CHyp, 194.1 ± 24.3/121.4 ± 17.3 for HypUrg and 191.6 ± 34.3/121.7 ± 18.8 mmHg for HypEmerg, respectively (p-value< 0.0001 between groups). MMP-9 levels were statistically different between the HypEmerg (2.31 ± 0.2 ng/mL) and HypUrg groups (2.17 ± 0.3 ng/mL) compared to the NT (1.94 ± 0.3 ng/mL) (p-value < 0.01 and p-value < 0.05, respectively) and CHyp groups (1.92 ± 0.2 ng/mL) (p-value < 0.01). Uric acid was the only independent variable for predicting MMP-9 levels (p-value = 0.001). Conclusion: MMP-9 concentrations are significantly higher in the hypertensive crisis groups (urgency and emergency) compared to the control groups. Therefore, MMP-9 may be a biomarker or mediator of pathophysiologic pathways in cases of acute elevations of blood pressure.

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Section: Discussionmentioning

confidence: 99%

Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis

Valente

Andrade

Cosenso-Martin

et al. 2020

BMC Cardiovasc Disord

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“…La HTA en la población adulta es el factor de riesgo cardiovascular más prevalente y uno de los que motiva un mayor número de consultas. Para alcanzar el control de la presión arterial es preciso poner en marcha un proceso complejo que abarca desde la prevención primaria, la detección precoz de los hipertensos, su tratamiento más adecuado, la normalización de las cifras tensionales, hasta la (22)(23)(24)(25)(26)(27)(28) garantía de un seguimiento indefinido .…”

Section: Discussionunclassified

Clinical characteristics of patients with hypertensive crisis who attend a medical emergency service

Bello

Pederzani

Fretes

et al. 2020

Rev. virtual Soc. Parag. Med. Int

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Introducción: los niveles de presión arterial por encima de las cifras normales aumentan el riesgo de padecer enfermedades cardiovasculares y cerebrales. Las complicaciones ocasionadas por las crisis hipertensivas son muy peligrosas y a menudo fatales. Es de suma importancia conocer bien sus características clínicas para tratar de contrarrestar su evolución. Objetivo: describir el comportamiento de las crisis hipertensivas en 500 pacientes del Servicio de Emergencias del Hospital de Clínicas, en el período de enero a junio de 2018. Metodología: estudio descriptivo y retrospectivo. Se utilizaron las hojas de recepción, acogida y clasificación de urgencias y las historias clínicas de pacientes ingresados con crisis hipertensivas. Se emplearon frecuencias absolutas y relativas (porcentaje) para resumir la información, y tablas para su presentación. Resultados: en el estudio predominó el sexo masculino, con 351 (70%) pacientes, y 149 (30%) de sexo femenino. El grupo etario en el que existió mayor predominio de pacientes (49%) fue el de 50-59 años de edad. Se observó un predominio de las urgencias hipertensivas con 399 (79,8%) pacientes, mientras que solo 101 (20,2%) pacientes desarrollaron emergencias hipertensivas. El órgano diana más frecuentemente dañado fue el cerebro en 43 (42,6%) pacientes con un accidente vascular cerebral, seguido por el síndrome coronario agudo en 34 (33,7%) pacientes. La alteración electrocardiográfica mas frecuente fue la hipertrofia del ventrículo izquierdo en 187 (37,4%) pacientes, y en segundo lugar se encontró el supradesnivel del ST, que se presentó en 111 (22,2%) pacientes.

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“…In 2006, the ACEP recommended that a patient with a single elevated BP should be further screened as an outpatient and that “persistently elevated” BPs are an accurate and reliable tool for diagnosing asymptomatic HTN necessitating outpatient referral . There is no benefit from rapidly lowering asymptomatic HTN, and, in fact, treatment is unnecessary and potentially harmful . Nonetheless, if BP is to be lowered, it should be decreased gradually without an expectation to normalize BP in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…However, because of provider perceptions about falsely elevated rates of acute adverse events (ie, stroke, myocardial infarction, death), ED treatment with antihypertensive medications can exceed 75% when BPs are ≥160/100 mm Hg . It appears that the desire to treat the elevated BP is compelling despite the lack of symptoms, when, in reality, treatment is unnecessary and may in fact be harmful …”

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confidence: 99%

Survey of Emergency Physician Approaches to Management of Asymptomatic Hypertension

Brody

Twiner

Kumar

et al. 2016

J of Clinical Hypertension

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Uncontrolled hypertension (HTN) is commonly encountered in emergency medicine practice, but the optimal approach has not been delineated. Our objective in this study is to define emergency physician (EP) approaches to management of asymptomatic HTN in various clinical scenarios, and assess adherence to the American College of Emergency Physician clinical policies, utilizing an online survey of EPs. 1,200 surveys were distributed by email with completion by 199 participants. The variables associated with a decision to prescribe oral antihypertensives were a history of HTN and referral from primary care. Acute BP reduction using intravenous antihypertensives was also more likely with the latter and BP greater than 180/120 mmHg. Logistic regression revealed association of EP female gender, fewer years in practice, and high volume practice setting with guideline concordant therapy. Wide variability exists in EP approach to patients with asymptomatic HTN. Treatment decisions were impacted by patient history of chronic HTN, referral from PCP, and magnitude of BP elevation.

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Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort

Cited by 56 publications

References 20 publications

Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis

Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis

Clinical characteristics of patients with hypertensive crisis who attend a medical emergency service

Survey of Emergency Physician Approaches to Management of Asymptomatic Hypertension

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