Effects of acute blood pressure elevation on biochemical-metabolic parameters in individuals with hypertensive crisis

Abstract

Hypertensive crisis is a common clinical situation that presents a high rate of morbidity and mortality and it is characterized by symptomatic rise of blood pressure (BP), systolic (SBP) ≥ 180 mmHg and/or diastolic (DBP) ≥ 120 mmHg. It is classified as emergency (HE) or hypertensive urgency (HU). There is no description of laboratory findings in patients who present acute BP elevation. Thus, this study had the objective to assess the biochemical-metabolic parameters of patients with HC. We studied 74 normotensive individuals (NT), 74 controlled hypertensive patients (ContrHT), 50 subjects with HU, and 78 with HE for evaluating biochemical-metabolic parameters. HE occurs in older individuals and more frequently in those with known hypertension. More patients with HE had dyslipidemia than those with HU (58% vs. 38%). The diastolic BP and heart rate were higher in the HE group (120 mmHg and 87 bpm) compared to ContrHT (71 mmHg and 71 bpm; p < 0.0001) and NT groups (75 mmHg and 68 bpm; p < 0.0001). Glycemia was higher in HE vs. NT and ContrHT (p < 0.05). HDL cholesterol was lower in HE than NT (p = 0.0088). Potassium was lower in HE vs. NT, ContrHT and HU groups (p < 0.05). Creatinine was higher in the HC group vs. NT and ContrHT (p < 0.05). The GFR was significantly lower in HE group vs. HU, ContrHT and NT (p < 0.001). In conclusion, individuals with HC show biochemical alterations when compared to ContrHT and NT. Acute BP elevations are associated with hyperglycemia, dyslipidemia, and higher potassium and creatinine levels and lower renal function. Abbreviations BMI = body mass index BP = blood pressure CH = hypertensive crisis ContrHT = controlled hypertensive DBP = diastolic blood pressure GFR = glomerular filtration rate HbA1c = glycated hemoglobin HDLc = high-density lipoprotein cholesterol HE = hypertensive emergency HPLC = high-performance liquid chromatography HR = heart rate HU = hypertensive urgency JNC 7 = VII Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure LDLc = low-density lipoprotein cholesterol MDRD = Modification of Diet in Renal Disease NT = normotensive RASB = renin-angiotensin system blockers SBP = systolic blood pressure TC = total cholesterol TG = triglycerides.

Inflammatory Cytokines are Associated to Lower Glomerular Filtration Rate in Patients with Hypertensive Emergency

“…In the present study, markers of renal function (creatinine and eGFR) were altered in individuals with HUrg and HEmerg. These two groups demonstrated upper creatinine levels and decrease in the eGFR compared to the control groups (NT and ContrHT), data confirmed by other studies investigating acute elevations of BP [18,19]. Moreover, HEmerg group evidenced declines in the eGFR compared to the HUrg group.…”

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

“…The profile of the patients studied showed that the mean age was in the fifth decade of life, not differing from other studies that also evaluated the profile of patients with hypertensive crisis. ( 12 , 13 ) In the present study, age was a relevant variable because in the multivariate analysis it was associated to hypertensive crisis, reducing by 0.32 times the probability of a hypertensive pseudocrisis, and reducing by 0.50 times the probability of a hypertensive urgency, compared to patients with hypertensive emergency. These results have never been published before, as nothing was found in the literature on the subject with analysis by multinomial logistic regression.…”

“…O perfil dos pacientes estudados mostrou que a média de idade se manteve na faixa da quinta década, não diferindo de achados de outros estudos que também avaliaram o perfil de pessoas com crise hipertensiva. ( 12 , 13 ) No presente estudo, a idade foi variável relevante, pois, na análise multivariada, ela manteve-se associada à crise hipertensiva, reduzindo a chance em 0,32 vez para o desenvolvimento de pseudocrise hipertensiva e em 0,50 vez a chance de urgência hipertensiva, em relação aos pacientes com emergência hipertensiva. Estes resultados são inéditos, tendo em vista a não identificação de achados na literatura sobre o assunto com análise por regressão logística multinomial.…”

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

“…Al comparar los resultados del estudio con otros respecto a los tipos de emergencias hipertensivas diagnosticadas, se establece una coincidencia con otros estudios en los que se reporta que una de las (34)(35)(36) emergencias hipertensivas más frecuentes es el accidente vascular encefálico . Cuando se analizan los resultados en relación con los síntomas mas frecuentes que se presentan en los pacientes, se (37-observa un predominio de la cefalea, lo que coincide con los resultados obtenidos por otros estudios 39) .…”