Hypertension Management in Emergency Departments

Miller, Joseph; McNaughton, Candace D.; Joyce, Katherine; Binz, Sophia; Levy, Phillip D.

doi:10.1093/ajh/hpaa068

Cited by 9 publications

(6 citation statements)

References 64 publications

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“…The current European position paper [ 12 ] suggests that HU should be treated in the same way as asymptomatic uncontrolled hypertension, by modifying home therapy without claiming rapid BP reduction in the emergency room. In these patients, oral administration of antihypertensive drugs, aimed at gradual BP reduction over the following days, is the best approach [ 37 – 39 ].…”

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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“…5 A basic metabolic profile including a complete blood count, urinalysis, ECG, and chest x-ray is indicated in all patients with a suspected hypertensive emergency. 11 Further investigations should be symptom-based and related to the differential diagnosis. 5 Cardiac enzymes should be performed in patients with acute coronary events but were not performed in this case due to limited facilities.…”

Section: Discussionmentioning

confidence: 99%

Non-ST Elevation Acute Coronary Syndrome (NSTEACS) as Hypertension-Mediated Organ Damage (HMOD) in Hypertensive Emergencies

Puspaseruni¹,

Rizka²,

Sakulat³

2023

Cermin Dunia Kedokteran

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Hypertensive emergencies are characterized by severe increases in blood pressure with evidence of hypertension-mediated organ damage (HMOD) and are associated with an increased risk of cardiovascular events, i.e. coronary heart disease (CHD) and mortality. Case: A 75-year-old man with typical chest pain with nausea and vomiting 1 hour before admission. Blood pressure was 200/100 mmHg, ECG showed T inversion in leads II, III, AVF, V1-V6 and prolonged QT interval, cardiomegaly on chest x-ray, and leukocytosis, hyperglycemia, and hypokalemia. The diagnoses were non-ST elevation acute coronary syndrome (NSTE-ACS), hypertensive emergency, and T2DM. Treatment in the ICCU consists of intravenous antihypertensive, antiplatelet, anticoagulant, statin, nitrate, insulin, and potassium chloride for electrolyte correction. The patient was admitted to the ICCU for further observation and management. Hipertensi emergensi ditandai dengan kenaikan tekanan darah yang sangat disertai bukti kerusakan organ yang progresif (hypertension-mediated organ damage - HMOD). Keadaan ini berkaitan dengan peningkatan risiko kejadian penyakit kardiovaskular, seperti penyakit jantung koroner bahkan kematian. Kasus: Seorang laki-laki usia 75 tahun dengan nyeri dada tipikal sejak 1 jam sebelum datang ke rumah sakit disertai mual dan muntah. Tekanan darah 200/100 mmHg, pada EKG didapatkan inversi T pada lead II, III, AVF, V1-V6, dan pemanjangan interval QT. Pada pemeriksaan X-ray dada didapatkan kardiomegali, hasil laboratorium menunjukkan leukositosis, hiperglikemi, dan hipokalemi. Pasien didiagnosis non-ST elevation acute coronary syndrome (NSTE-ACS), hipertensi emergensi, dan diabetes melitus tipe 2. Tata laksana di ICCU menggunakan anti-hipertensi intravena, anti-platelet, anti-koagulan, statin, nitrat, insulin, dan kalium klorida untuk koreksi elektrolit. Pasien dirawat di ICCU untuk observasi dan tata laksana lebih lanjut.

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“…Uncontrolled high blood pressure is associated with increased risk for preventable emergency department (ED) visits. From 2006 to 2012, in the most recent analysis available on ED use and high blood pressure, ED visits caused by high blood pressure increased by 4% each year (4). Among all ED users in the US, an estimated 45% have high blood pressure (5).…”

Section: Introductionmentioning

confidence: 99%

Shared Decision-Making and Emergency Department Use Among People With High Blood Pressure

Yakubu,

Coleman,

Ainyette

et al. 2023

Prev. Chronic Dis.

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What is already known on this topic? Several studies have assessed the relationship among chronic disease, shared decision-making, and health care use, but information is limited on the relationship among high blood pressure, shared decision-making, and use of emergency department services.What is added by this report?Findings from this report provide insight on how predisposing, enabling, and need factors based on the Andersen model contribute to shared decision-making and emergency department use.What are the implications for public health practice?Future studies can expand on the perceived use of shared decisionmaking among people with chronic disease to improve outcomes and types of health care services used.

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Hypertension Management in Emergency Departments

Cited by 9 publications

References 64 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

Non-ST Elevation Acute Coronary Syndrome (NSTEACS) as Hypertension-Mediated Organ Damage (HMOD) in Hypertensive Emergencies

Shared Decision-Making and Emergency Department Use Among People With High Blood Pressure

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