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'Hypertensive Emergencies' (939)


Jan
2018

Currently, the prevention and treatment of hypertensive crises especially when it occurs with serious adverse outcomes have led to worldwide controversy. Despite of clinical possibilities of multiple agents, clinical failures still occur frequently. Therefore, early evaluations and observations of different therapies on appropriate animals should be emphasized.

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Feb
2018

Type 2 myocardial infarction (MI) is characterized by an imbalance between myocardial blood supply and demand, leading to myocardial ischemia without coronary plaque rupture, but its diagnosis is challenging.
In the TRACER trial, patients with non-ST-segment elevation acute coronary syndromes were included. We aimed to describe provoking factors, cardiac biomarker profiles, treatment patterns, and clinical outcomes of patients with type 2 MIs.

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Feb
2018

Obstetric near-miss or severe acute maternal morbidity is gaining interest internationally as a new indicator of the quality of obstetric care. This is a retrospective study conducted using "The WHO Near-Miss Approach" to provide insight into obstetric emergencies, near-miss cases, and maternal deaths in our hospital. The maternal near-miss ratio was 8.

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Nov
2017

High blood pressure is a problem with elevated prevalence in the world population. The acute forms of presentation are "hypertensive crises," which represent a frequent cause for emergency room and primary care consultations. Hypertensive crises are divided into hypertensive emergencies and hypertensive urgencies, depending on whether or not there is acute damage to the target organ, respectively.

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Feb
2018

Heart disease in pregnancy may manifest as acute coronary syndromes, decompensated valvular disease, and acute heart failure. These disease processes may represent progression of preexisting disease versus newly developed disease resulting from the physiologic changes of pregnancy. Early recognition of clinical presentations, judicious use of diagnostic studies, and multidisciplinary management of patient and fetal considerations can lead to optimal outcomes in this unique patient subset.

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Dec
2017

To evaluate the impact of blood pressure variability (BPV) on cardiovascular outcomes in patients with acute coronary syndrome, short-term BPV was estimated by using weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings. The primary outcome was in-hospital major adverse cardiac events (MACE). Overall, 200 patients (mean age, 58.

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Dec
2017

Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first "medically clear" the patient as stable for transfer.

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Dec
2017

Postpartum Headache.

Adv Emerg Nurs J 2017 Oct/Dec;39(4):258-265
Kathleen J Richardson
Approximately 40% of all women report experiencing headaches during the postpartum period, regardless of a previous headache history. This case narrative describes the clinical case of a 22-year-old woman who presented for the evaluation of an intractable headache for 2½ weeks. It demonstrates the inherent difficulty in diagnosing patients not presenting with "textbook" symptoms and highlights the fact that signs and symptoms of eclampsia/preeclampsia, such as elevated blood pressure, may fall below the threshold for hypertensive emergencies and not be considered in the differential.

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Sep
2017

Systemic hypertension and non-cardiac surgery.

Indian J Anaesth 2017 Sep;61(9):697-704
Satyajeet Misra
Primary systemic hypertension affects 10%-25% of individuals presenting for surgery and anaesthesia and constitutes an important cause of cancellation of elective surgeries. Much of the fear stems from the fact that hypertension may lead to adverse perioperative outcomes. Although long-standing hypertension increases the risk of stroke, renal dysfunction or major adverse cardiovascular events, the same is usually not seen in the perioperative period if blood pressure is <180/110 mmHg and this has been the overriding theme in the recent guidelines on perioperative blood pressure management.

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Sep
2017

[Hypertensive emergencies].

Dtsch Med Wochenschr 2017 Sep 22;142(19):1437-1445. Epub 2017 Sep 22.
Gerd Bönner
Hypertensive urgency and hypertensive emergency are associated with sudden, massive rise in blood pressure. An acute increase in blood pressure to values above 180/120 mmHg is considered critical. If not treated in time, it can quickly enter a life-threatening hypertensive emergency.

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Dec
1969

Treatment of acute emergencies in patients with pulmonary arterial hypertension (PAH) can be challenging. In the UK and Ireland, management of adult patients with PAH is centred in eight nationally designated pulmonary hypertension (PH) centres. However, many patients live far from these centres and physicians in local hospitals are often required to manage PAH emergencies.

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Aug
2017

While moderate to severely elevated blood pressure (BP) is present in nearly half of all emergency department (ED) patients, the incidence of true hypertensive emergencies in ED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency.

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Dec
1969

There is a paucity of good quality evidence regarding the best therapeutic option for acute control of blood pressure during acute hypertensive emergency of pregnancy.
We sought to compare the efficacy of intravenously administered hydralazine and oral nifedipine for acute blood pressure control in acute hypertensive emergency of pregnancy.
In this double-blind, randomized, controlled trial, pregnant women (≥24 weeks period of gestation) with sustained increase in systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg were randomized to receive intravenous hydralazine injection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection every 20 minutes until the target blood pressure of 150 mm Hg systolic and ≤100 mm Hg diastolic was achieved.

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Nov
2017

Long-term mortality in patients with acute severe hypertension is unclear. The authors aimed to compare short-term (hospital) and long-term (12 months) mortality in these patients. A total of 670 adults presenting for acute severe hypertension between January 1, 2015, and December 31, 2015, were included.

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Jun
2017

Hypertension can present in crisis form as 'hypertensive urgency'(HU) or as 'hypertensive emergency' (HE). Both the conditions are associated with significant morbidity and mortality.
To evaluate the clinical characteristics, course of illness, end-organ damage and survival outcome in patients with hypertensive crisis.

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Nov
2017

Acute severe hypertension occurs infrequently in pediatric patients and, consequently, data on the efficacy and safety of most antihypertensive agents, as well as the adverse events associated with these agents, are very limited in this population. In this case series, we evaluated the use of metoprolol infusion in children with hypertensive emergencies.
The study population comprised children younger than 18 years who had been admitted to the pediatric intensive care unit at King Abdullah University Hospital with blood pressure above the 99th percentile for age, height, and sex and who were symptomatic at the time of presentation.

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Oct
2017

Intravenous vasodilators are often added to beta-blocking agents to reach blood pressure (BP) goals in aortic dissection. Control of BP using clevidipine has been described in hypertensive emergencies and cardiac surgery but not in aortic dissection. The aim of this study was to compare clevidipine versus sodium nitroprusside (SNP) as adjunct agents to esmolol for BP management in aortic dissection.

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May
2017

To study the prevalence of hypertensive emergencies in an ICU set up and to study the clinical presentation of hypertensive emergencies related to cardiovascular, neurological and renovascular system.
Type of Study: Cross-sectional, descriptive study.
Two years from 1st December 2011 till 30th November 2013.

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May
2017

Treatment of hypertensive emergencies.

Ann Transl Med 2017 May;5(Suppl 1):S5
Wilbert S Aronow

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Jul
2017

Prehospital hypertensive emergencies and urgencies are common, but evidence is lacking. Telemedically supported hypertensive emergencies and urgencies were prospectively collected (April 2014-March 2015) and compared retrospectively with a historical control group of on-scene physician care in the emergency medical service of Aachen, Germany. Blood pressure management and guideline adherence were evaluated.

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Oct
2017

This observational retrospective cohort study was conducted to compare oral nifedipine and labetalol for emergency treatment of hypertension in preeclamptic patients. Time (minutes) and necessary doses were outlined to achieve blood pressure lower than 150/95 mmHg. In 14 patients with preeclampsia, 55 hypertensive emergencies were identified (BP >150/95).

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Apr
2017

Hypertension affects one-third of Americans and is a significant modifiable risk factor for cardiovascular disease, stroke, renal disease, and death. Severe asymptomatic hypertension is defined as severely elevated blood pressure (180 mm Hg or more systolic, or 110 mm Hg or more diastolic) without symptoms of acute target organ injury. The short-term risks of acute target organ injury and major adverse cardiovascular events are low in this population, whereas hypertensive emergencies manifest as acute target organ injury requiring immediate hospitalization.

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Jul
2017

To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.
A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).

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Jul
2017

Hypertensive urgency (HU) is a common reason particularly for elderly patients to seek medical advice. Severe asymptomatic hypertension and situational high blood pressure (BP) in patients with its high variability is frequently taken as HU. The use of short-acting antihypertensive drugs is not only indicated in these situations, but it may also increase the risk of cardiovascular events (CVE).

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May
2017

Hypertensive Emergency.

Med Clin North Am 2017 May 2;101(3):465-478. Epub 2017 Mar 2.
Manish Suneja, M Lee Sanders
A rapid and severe increase in blood pressure resulting in new or progressive end-organ damage is defined as hypertensive emergency. Clinicians should effectively use the patient interview, physical examination, and additional testing to differentiate hypertensive emergency from nonemergent hypertension. Patients with evidence or high suspicion for end-organ damage should be expediently referred from the outpatient setting to a higher level of care.

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Dec
1969

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes.

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Apr
2017

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes.

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Aug
2017

The ocular fundus examination is infrequently and poorly performed in the emergency department (ED) clinical settings, placing patients at risk for missed diagnosis of hypertensive emergencies. The aim of this study was to investigate the feasibility of the ocular fundus photography with a smartphone small optical device in an ED setting and to compare it with a traditional ocular fundus examination.
The study included 52 consecutive patients (mean age 69 ± 16 years, 50% women) presenting to a hospital ED with an acute increase in blood pressure (SBP > 180 and/or DBP > 100 mmHg).

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Mar
2017

Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements.

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Apr
2017

Hypertensive disorders of pregnancy result in significant maternal morbidity and mortality. State and national guidelines have been proposed to increase treatment of patients with hypertensive emergencies or critically elevated blood pressures. There are limited data available to assess the impact of these recommendations on maternal morbidity.

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Dec
1969

Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-specific symptoms, whereas heart-related symptoms (dyspnea, chest pain, arrhythmias, and syncope) are less common.

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Mar
2017

Hypertension is a major cause of mortality and morbidity today. The "silent" nature of hypertension makes it critical to determine its prevalence and its severity in the general public and to identify strategies to identify people unaware of its presence. A mobile hypertension awareness campaign was created to: (i) determine the prevalence and types of hypertension in an urban North American center, (ii) increase hypertension awareness, and (iii) identify reasons for lack of therapy adherence.

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Nov
2016

Hypertensive crises lumped several clinical situations with different seriousness and prognosis. The differences between hypertensive urgency and hypertensive emergency depends on if this situation involves a vital risk for the patient. This risk is defined more by the severity of the organ damage than for the higher values of blood pressure.

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Aug
2017

Posterior reversible encephalopathy syndrome.

J Neurol 2017 Aug 4;264(8):1608-1616. Epub 2017 Jan 4.
Marlene Fischer, Erich Schmutzhard
The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits. In a majority of patients the clinical presentation includes elevated arterial blood pressure up to hypertensive emergencies. Neuroimaging, in particular magnetic resonance imaging, frequently shows a distinctive parieto-occipital pattern with a symmetric distribution of changes reflecting vasogenic edema.

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Oct
2016

Perinatal morbidity in sub-Saharan Africa has been attributed to infection, obstetric emergencies, and preterm birth, but less is known about hypertension in pregnancy. Our objective was to characterize the prevalence of hypertension in pregnancy and the impact of hypertension on perinatal outcomes in sub-Saharan Africa.
We performed surveillance of obstetric records at eight of the largest public hospitals in Botswana.

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Dec
2016

The incidence of hypertensive emergency in US emergency departments (ED) is not well established.
This 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.

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Feb
2017

To test the hypothesis that more cardiovascular emergencies occur at low rather than at high temperatures under moderate climatic conditions.
This was a prospective observational study performed in a prehospital setting. Data from the Emergency Medical Service in Hamburg (Germany) and from the local weather station were evaluated over a 5-year period.

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Dec
2016

Glucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. This case report describes a patient with hypertension controlled on β blockers who, after glucagon administration during an intraoperative cholangiography, experienced hypertensive emergency despite adequate pain control.

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Jul
2016

The prevalence and short-term outcomes of hypertensive urgency (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) are unknown. Guidelines recommend achieving blood pressure control within 24 to 48 hours. However, some patients are referred to the emergency department (ED) or directly admitted to the hospital, and whether hospital management is associated with better outcomes is unknown.

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Dec
1969

It is inexorable that a proportion of patients with systemic arterial hypertension will develop a hypertensive crisis at some point in their lives. The hypertensive crises can be divided in hypertensive patients with emergency or hypertensive emergency, according to the presence or absence of acute end-organ damage. In this review, we discuss the cardiovascular hypertensive emergencies, including acute coronary syndrome, congestive heart failure, aortic dissection and sympathomimetic hypertensive crises (those caused by cocaine use included).

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Jun
2016

Evaluation of the prevalence and severity of hypertensive emergencies and crisis in an Emergency Service of Timone hospital in Marseille and follow-up of 3 months of hospitalized emergencies.
This study was conducted in the Emergency Department between April 1 and June 30, 2015. All patients with BP>180 and/or 110mmHg was recorded and classified in true emergencies (presence of visceral pain) and hypertensive isolated crisis.

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Dec
1969

Minimal invasive approaches to pheochromocytoma (PCC) and paraganglioma (PGL) removal may be complicated by the hemodynamic disturbances that are associated with the catecholamine secretion from the tumour. The anaesthetic and perioperative monitoring techniques need to be customized to handle these complications effectively. This retrospective analysis was undertaken to review the perioperative management of these patients handled by the same anaesthetic and surgical team.

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Dec
1969

Clinicians make frequent treatment decisions regarding acute blood pressure reduction for the critically ill. Key to the decision making process is a balance between reducing arterial wall stress and maintaining perfusion to vital organs. In this article, we review the physiological considerations underlying acute blood pressure management, including the concept of cerebral autoregulation and its adaptations to chronic hypertension.

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Nov
2016


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Dec
1969

Evaluation and treatment of hypertensive crises in children.

Integr Blood Press Control 2016 16;9:49-58. Epub 2016 Mar 16.
Deborah R Stein, Michael A Ferguson
Hypertensive crises in children are medical emergencies that must be identified, evaluated, and treated promptly and appropriately to prevent end-organ injury and even death. Treatment in the acute setting typically includes continuous intravenous antihypertensive medications with monitoring in the intensive care unit setting. Medications commonly used to treat severe hypertension have been poorly studied in children.

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Feb
2016

Nephrology emergencies are not the most frequent in the emergency room but they often generate some diagnostic and therapeutic problems. Most common renal emergencies are due most often to acute renal failure whatever the cause, electrolytes disturbances, hypertensive crisis and less frequently intoxications or acute decompensation of chronic kidney diseases. The goal of this paper is to review some of these clinical situations both in the diagnostic and therapeutic perspective but essentially to discuss when the nephrologist should be called in the emergency room so that the coordination of care is optimal for the patients.

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Dec
1969

The expression 'hypertensive urgencies' includes many diseases. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs. The aim of the review was to define the idea of the 'acute hypertension' as a new concept, different from 'chronic hypertension'.

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Mar
2016

Blood pressure (BP) monitoring devices are very commonly used by the general public for self-measurement. Approximately 19% of people using these devises check their BP every day or almost every day and only one third use them because their doctor recommended it. Measurement often causes anxiety and anxiety increases blood pressure in the short term.

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