Hypertensive Emergencies in the Emergency Department

Adebayo, Omoyemi; Rogers, Robert L.

doi:10.1016/j.emc.2015.04.005

Cited by 35 publications

(25 citation statements)

References 35 publications

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“…Our primary finding is that ED visits for hypertensive emergency, that is, ED visits for patients who have markedly elevated BP with acute target organ damage and an acuity level high enough to necessitate hospital admission, are quite rare, accounting for less than 2 in 1000 adult ED visits and 6 in 1000 visits carrying any diagnosis of hypertension in 2013. Thus, while markedly elevated BP at presentation to the ED is quite common, occurring in nearly 20% of patients, the likelihood that it represents a true hypertensive emergency may be lower than previously thought …”

Section: Discussionmentioning

confidence: 96%

“…Thus, while markedly elevated BP at presentation to the ED is quite common, 21,22 occurring in nearly 20% of patients, 23 the likelihood that it represents a true hypertensive emergency may be lower than previously thought. 12 By definition, true hypertensive emergencies are an indication for rapid BP lowering. The management of hypertensive emergency is to limit and reverse target organ damage, but not to achieve a "normal" BP.…”

Section: Discussionmentioning

confidence: 99%

“…At present, the only existing comprehensive epidemiological data related to this come from 1 study of a Brazilian population, where hypertensive emergencies were found to be present in 0.3% of all ED visits. 11 Despite the limited empirical evidence, there are claims in the literature that hypertensive emergencies make up as much as one fourth of all ED visits, 12 orders of magnitude more than existing estimates. Such uncertainty about the incidence of hypertensive emergencies occurs in the context of a significant and growing perspective that hypertension is a public health problem.…”

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confidence: 99%

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Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Janke

McNaughton

Brody

et al. 2016

JAHA

104

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BackgroundThe incidence of hypertensive emergency in US emergency departments (ED) is not well established.Methods and ResultsThis study is a descriptive epidemiological analysis of nationally representative ED visit‐level data from the Nationwide Emergency Department Sample for 2006–2013. Nationwide Emergency Department Sample is a publicly available database maintained by the Healthcare Cost and Utilization Project. An ED visit was considered to be a hypertensive emergency if it met all the following criteria: diagnosis of acute hypertension, at least 1 diagnosis indicating acute target organ damage, and qualifying disposition (admission to the hospital, death, or transfer to another facility). The incidence of adult ED visits for acute hypertension increased monotonically in the period from 2006 through 2013, from 170 340 (1820 per million adult ED visits overall) to 496 894 (4610 per million). Hypertensive emergency was rare overall, accounting for 63 406 visits (677 per million adult ED visits overall) in 2006 to 176 769 visits (1670 per million) in 2013. Among adult ED visits that had any diagnosis of hypertension, hypertensive emergency accounted for 3309 per million in 2006 and 6178 per million in 2013.ConclusionsThe estimated number of visits for hypertensive emergency and the rate per million adult ED visits has more than doubled from 2006 to 2013. However, hypertensive emergencies are rare overall, occurring in about 2 in 1000 adult ED visits overall, and 6 in 1000 adult ED visits carrying any diagnosis of hypertension in 2013. This figure is far lower than what has been sometimes cited in previous literature.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Janke

McNaughton

Brody

et al. 2016

JAHA

104

View full text Add to dashboard Cite

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“…There is disruption of the blood brain barrier and endothelium; and ultimately cerebral edema ensues. In normotensive patients there is lower threshold of hypertensive encephalopathy because there brain is not adapted to even moderately increased blood pressures [16]. A large number of these cases are seen with acute strokes, as they themselves can cause alterations in the blood brain barrier and cerebral auto-…”

Section: Hypertensive Encephalopathymentioning

confidence: 99%

“…Differential diagnoses include ischemic and hemorrhagic stroke, infection, and reversible cerebral vasoconstriction syndrome [16]. Rapid blood pressure lowering is the main treatment strategy, however, decrease in mean arterial pressure should not be more than 20-25% in the first hour of medication administration.…”

Section: Journal Of Headache and Pain Management Issn 2472-1913mentioning

confidence: 99%

Headache: When to Worry

Ts¹,

Singh²,

Rastogi³

et al. 2016

J Headache Pain Manag

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Headaches are a common emergency department presentation, and workup should focus on looking for potentially dangerous etiologies. In this paper, the authors review causes of non-benign headache, including cervical artery dissection, cerebral venous thrombosis, pseudotumor cerebri, hypertensive encephalopathy, acute angle glaucoma, hydrocephalus, giant cell arteritis, meningitis, and subarachnoid hemorrhage.

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