New Developments in Hypertensive Encephalopathy

Miller, Joseph; Suchdev, Kushak; Jayaprakash, Namita; Hrabec, Daniel; Sood, Aditya; Sharma, Snigdha; Levy, Phillip D.

doi:10.1007/s11906-018-0813-y

Cited by 34 publications

(54 citation statements)

References 41 publications

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“…1). In this sense, an interrelation between CHS and HE [1,10,11], HE and PRES [13], and PRES and RCVS has been described [14][15][16]. We support the pos sibility of an interrelation among all of them, and between the luxury perfusion syndrome and CHS.…”

Section: Chs and Related Conditionssupporting

confidence: 75%

Cerebral Hyperperfusion Syndrome and Related Conditions

Delgado

Bogousslavsky

2020

Eur Neurol

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Cerebral vasoconstriction is a normal physiological response under determined conditions to preserve a normal cerebral blood flow. However, there are several syndromes, with impaired cerebral autoregulation and cerebral vasoconstriction, not related with infection or inflammation, which share the same radiological and clinical presentation. We review here the cerebral hyperperfusion syndrome and related conditions such as hypertensive encephalopathy, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome. These syndromes might share the same pathophysiological mechanism with endothelial damage, cerebral vasoconstriction, blood-brain barrier disturbance, cerebral edema, and, occasionally, intracerebral hemorrhage, with fatal cases described in all. Despite knowledge of these syndromes, they still remain unknown to us. Why these entities present in some patients and not in others goes further than the actual understanding of these diseases. We have to consider that a genetic susceptibility and molecular disturbances may be involved. Thus, more studies are needed in order to better characterize such syndromes.

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Section: Chs and Related Conditionssupporting

confidence: 75%

Cerebral Hyperperfusion Syndrome and Related Conditions

Delgado

Bogousslavsky

2020

Eur Neurol

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“…Patients suffering from hypertensive encephalopathy often have alterations in mental status, or accompanied by seizures, visual disturbance, or headache [29]. However, in our study, patients with hypertensive encephalopathy according to the ICD-9 code has been excluded from the study cohort, and the highest systolic pressure in the study cohort was 180 mmHg, less than the typically lower limit of systolic pressure (220 mmHg) that may cause hypertensive encephalopathy.…”

Section: Discussionmentioning

confidence: 94%

The effect of conscious disorder on the 30-day mortality of sepsis

Yang

Liang

Wang

et al. 2020

Preprint

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Background Conscious impairment is related to worse prognosis in patients with sepsis. we aimed to evaluate the impact of conscious disorder on the 30-day mortality of patients with sepsis and identify the remediable risk factors for it. Methods Data were retrospectively retrieved from a prospective intensive care database. Conscious disorder was assessed by the Glasgow Coma Score (GCS). The impact of conscious dysfunction on the 30-day mortality of sepsis and its potentially modifiable risk factors were evaluated using Cox proportional hazard regression and logistic regression, respectively. Results A total of 4446 patients with sepsis were included in the study and conscious disorder (GCS < 15) was observed in 2126 (47.8%) patients. The results of Cox regression and Kaplan-Meier analysis demonstrated that GCS ≤ 12 contributed to the increased 30-day mortality of patients with sepsis and was an independent risk factor for it. Considering the clinical risks and benefits, the results of logistic regression showed that hypertension (systolic pressure ≥ 140 mmHg), hypernatremia (serum sodium ≥ 145 K/uL), the utility of cephalosporin and urinary infection are the potentially remediable risk factors for patients with sepsis characterized by GCS ≤ 12. Conclusion Moderate impairment of consciousness (GCS 9–12) and coma (GCS 3–8) were independently related to the 30-day mortality of sepsis. Potentially remediable risk factors for patients with sepsis characterized by GCS ≤ 12 at ICU admission were hypertension, hypernatremia, cephalosporin adoption and urinary infection. Further studies are needed to investigate the causal relationship between medical interventions towards these risk factors and the incidence of moderate impairment of consciousness and coma in patients with sepsis.

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“…If neither hemorrhage on computed tomography nor alternative reasons for altered mental status are present, magnetic resonance imaging may be warranted. 17 Likewise, biomarkers of cardiac injury (troponin) and stress (natriuretic peptides) should be obtained for patients with concurrent shortness of breath or chest pain, with the addition of computed tomography angiography of the thorax and abdomen when an acute aortic syndrome is suspected.…”

Section: Assessing and Treating Hypertensive Emergenciesmentioning

confidence: 99%

“…In hypertensive encephalopathy, BP exceeds limits of autoregulation and directly injures the vascular endothelium, leading to cerebral vasodilation and retinal injury often accompanied by glomerular injury and thrombotic microangiopathy. 9 , 17–19 Blood flow to cerebral, renal, and other vascular beds is tightly autoregulated to maintain constant perfusion, 20 but this autoregulation becomes overwhelmed at extreme elevations in BP. Each individual’s BP threshold for a loss of autoregulation, however, is dependent on adaption of their vascular beds.…”

Section: Assessing and Treating Hypertensive Emergenciesmentioning

confidence: 99%

“…While other etiologies for posterior reversible encephalopathy syndrome exist, such as renal disease, immunosuppressive therapy, erythropoietin use, and thrombotic thrombocytopenic purpura, acute, elevated BP is by far the most common cause. 17 Besides alterations in mental status, these patients often have seizures and visual changes. 22 Imaging findings, which typically require magnetic resonance imaging to detect, include vasogenic edema in the posterior brain, especially in the occipital–parietal regions.…”

Section: Assessing and Treating Hypertensive Emergenciesmentioning

confidence: 99%

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Hypertension Management in Emergency Departments

Miller

McNaughton

Joyce

et al. 2020

American Journal of Hypertension

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BACKGROUND Elevated blood pressure (BP) is pervasive among patients that visit emergency departments (EDs) for their care. METHODS In this review article, we outline the current approach to the management of these individuals and highlight the crucial role emergency medicine clinicians play in reducing the morbidity associated with elevated BP. RESULTS We highlight the critical importance of immediate treatment when elevated BP contributes to new or worsening end-organ injury but emphasize that such hypertensive emergencies are rare. For the vast majority of patients with elevated BP in the ED who do not have new or worsening end-organ injury from elevated BP, immediate BP reduction within the ED is not recommended or safe. Nonetheless, within weeks after an ED visit, there is a pressing need to improve the care of patients with elevated or previously undiagnosed hypertension. For many, it may be their only regular point of engagement with the healthcare system. To address this, we present novel perspectives that envision a new role for emergency medicine in chronic hypertension management—one that acknowledges the significant population-level gaps in BP control that contribute to disparities in cardiovascular disease and sets the stage for future changes in systems-based practice. CONCLUSIONS Emergency medicine plays a key and evolving role in reducing morbidity associated with elevated BP.

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New Developments in Hypertensive Encephalopathy

Cited by 34 publications

References 41 publications

Cerebral Hyperperfusion Syndrome and Related Conditions

Cerebral Hyperperfusion Syndrome and Related Conditions

The effect of conscious disorder on the 30-day mortality of sepsis

Hypertension Management in Emergency Departments

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