Characteristics and Management of Patients Presenting to the Emergency Department With Hypertensive Urgency

Bender, Seth R.; Fong, Michael W.; Heitz, Sabine; Bisognano, John D.

doi:10.1111/j.1524-6175.2005.04898.x

Cited by 42 publications

(28 citation statements)

References 27 publications

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“…Overall, only 6% obtained the tests recommended by the guidelines, and 10% had no tests performed. 66,67 The known duration of HTN and procuring the serum urea level at presentation have been found to be the main predictors of survival in hypertensive crisis, with poorer outcomes for black patients. 21 The 1-year mortality rate is 79% for patients with untreated hypertensive emergencies, 68 and 5-year survival rate among all patients who present with hypertensive crisis is 74%.…”

Section: Prognosismentioning

confidence: 98%

Hypertensive Crisis

Rodriguez

Kumar

2010

Cardiology in Review

139

116

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Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode.

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Section: Prognosismentioning

confidence: 98%

Hypertensive Crisis

Rodriguez

Kumar

2010

Cardiology in Review

139

116

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“…This was highlighted in a recent case series of adults presenting to the Emergency Department of a teaching hospital in the USA [7]. In that study, 90% of patients requiring intervention for a hypertensive urgency had a known diagnosis of hypertension; the most common contributing factors to the severe BP elevation included running out of prescribed medications and medication noncompliance.…”

Section: Etiologies Of Severe Hypertension In Children and Adolescentsmentioning

confidence: 94%

Severe hypertension in children and adolescents: pathophysiology and treatment

2009

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Severe, symptomatic hypertension occurs uncommonly in children, usually only in those with underlying congenital or acquired renal disease. If such hypertension has been long-standing, then rapid blood pressure reduction may be risky due to altered cerebral hemodynamics. While many drugs are available for the treatment of severe hypertension in adults, few have been studied in children. Despite the lack of scientific studies, some agents, particularly continuous intravenous infusions of nicardipine and labetalol, are preferred in many centers. These agents generally provide the ability to control the magnitude and rapidity of blood pressure reduction and should--in conjunction with careful patient monitoring--allow the safe reduction of blood pressure and the avoidance of complications. This review provides a summary of the underlying causes and pathophysiology of acute severe hypertension in childhood as well as a detailed discussion of drug treatment and the optimal clinical approach to managing children and adolescents with acute severe hypertension.

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“…Ophthalmologic manifestations as an isolated sign of discovery of this pathology are rare, which makes the singularity of our clinical case [6,10]. Lam et al [11] described a case of malignant hypertension in a 7-year-old girl with pheochromocytoma in the context of Von Hippel-Lindau syndrome.…”

Section: At the Clinical Levelmentioning

confidence: 99%

Malignant Hypertensive Retinopathy Revealing Bilateral Renal Atrophy in Adolescent at Chu-Campus of Lomé

Nononsaa¹,

Abbey²,

Amouzou³

et al. 2019

IJOVS

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Malignant hypertension, which was defined as the association of a severe elevation of blood pressure with retinopathy stage III or IV according to KEITH and WAGENER, now takes into account the involvement of the noble organs such as central nervous system, heart and kidneys. It is this attack that determines the severity, urgency and vital prognosis of this pathology. Uncommon in children and teenagers, malignant hypertension often secondary, involving kidney in the most cases. It is a therapeutic emergency because it is at risk to progress into hypertensive encephalopathy, stroke, acute renal failure, or heart failure, all of which represent its usual pattern of discovery. We report the case of malignant hypertension in a teenager without personal pass history of hypertension. The singularity of this report case is the uncommon mode of his discovery: isolated bilateral visual impairment. This clinical case challenges us and reminds the interest of the funduscopic examination during ophthalmological consultation, and teaches us that taking the blood pressure of a teenager who consults for an isolated bilateral decrease of vision is not without interest. Early recognition and management of malignant hypertension, are fundamental to any improvement in prognosis of this serious disease.

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Characteristics and Management of Patients Presenting to the Emergency Department With Hypertensive Urgency

Abstract: Hypertens. 2006;8:12-18)

Cited by 42 publications

References 27 publications

Hypertensive Crisis

Hypertensive Crisis

Severe hypertension in children and adolescents: pathophysiology and treatment

Malignant Hypertensive Retinopathy Revealing Bilateral Renal Atrophy in Adolescent at Chu-Campus of Lomé

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