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Hypertension urgency emergency

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https://www.readbyqxmd.com/read/28414672/a-strong-and-fortuitous-case-of-dyspnea
#1
R Hammer, M Sciaudone
CASE: A 48 year-old man with no past medical history was sent to our emergency department (ED); from a primary care clinic for hypertensive urgency of 200/130. The man reported an intermittent non-productive cough of approximately one year's duration and worsening dyspnea on exertion and orthopnea over the last month with lower extremity swelling. Of note, he emigrated from Honduras twenty years ago. Blood pressure normalized with administration of Lasix in the ED. Physical exam revealed rales in lung bases bilaterally, jugular venous distension, lower extremity pitting edema with serpiginous patches of erythema and excoriation, and a cardiac gallop...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28306673/hypertensive-crisis-an-update-on-clinical-approach-and-management
#2
Emrah Ipek, Ahmet Afşin Oktay, Selim R Krim
PURPOSE OF REVIEW: Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C. RECENT FINDINGS: HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively...
March 16, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28244897/comparing-the-clinical-efficacy-of-resting-and-antihypertensive-medication-in-patients-of-hypertensive-urgency-a-randomized-control-trial
#3
Sung Keun Park, Won Joong Kim, Dong-Young Lee, Sang Yoon Lee, Hyun Sun Park, Hae Won Kim, Beom Kim, Kyoung Hyoub Moon
OBJECTIVE: Hypertensive urgency is defined as a severe elevation of blood pressure (BP) without target organ damage. In emergency room, hypertensive urgency has been conventionally managed by antihypertensive medication. However, there has been increasing concern for the safety of antihypertensive medication in hypertensive urgency. Thus, this study was to compare the clinical efficacy of resting and antihypertensive medication in managing hypertensive urgency. METHODS: For 138 hypertensive urgency patients admitting in emergency room of Veterans Health Center hospital, a single-center, randomized controlled trial was conducted...
February 27, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28074727/-flank-pain-caused-by-a-renal-artery-dissection
#4
J C Karper, W M T Janssen, J C Breek, R Oosterhof-Berktas, J Gravendeel, T K Kremer Hovinga
BACKGROUND: A spontaneous renal artery dissection is a very rare diagnosis. The clinical presentation can vary and its course can be atypical. There are no guidelines available regarding treatment; however, the options are a conservative (medication) or interventional (radiological or surgical) approach. CASE DESCRIPTION: A 45-year-old man presented to the emergency department with hypertensive urgency after earlier episodes of flank pain. The cause appeared to be a spontaneous bilateral renal artery dissection with infarction...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28057629/alarming-prevalence-of-emergency-hypertension-levels-in-the-general-public-identified-by-a-hypertension-awareness-campaign
#5
Stephanie P B Caligiuri, Jose Alejandro Austria, Grant N Pierce
BACKGROUND: 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...
March 1, 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/28055998/-hypertensive-crisis-urgency-and-hypertensive-emergency
#6
Javier Sobrino Martínez, Mónica Doménech Feria-Carot, Alberto Morales Salinas, Antonia Coca Payeras
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. The hypertensive urgency not involves an immediately risk for the patient, for these reason, the treatment can be completed after discharged. Otherwise, the hypertensive emergency is a critical clinical condition that requires hospital assistance...
November 18, 2016: Medwave
https://www.readbyqxmd.com/read/28000548/hypertensive-crisis-pharmacotherapy-and-complications
#7
Priyanka Wani-Parekh, Carlos Garcia-Blanco, Melissa Mendez, Debabrata Mukherjee
Cardiovascular diseases (CVD) are the number one cause of death globally compared to any other cause. CVD accounts for approximately 17.3 million deaths per year and are rising. Hypertension is the leading risk factor for cardiovascular diseases. Approximately 80 million people suffer from hypertension in the U.S. While, majority of these individuals are on antihypertensive medications only 54% of individuals with hypertension are optimally controlled. Heart failure and stroke are some of the devastating complications of uncontrolled hypertension...
December 20, 2016: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/27984052/beta-adrenergic-receptor-blockers-in-hypertension-alive-and-well
#8
William H Frishman
Beta-adrenergic receptor blockers (β-blockers) are an appropriate treatment for patients having systemic hypertension (HTN) who have concomitant ischemic heart disease (IHD), heart failure, obstructive cardiomyopathy, aortic dissection or certain cardiac arrhythmias. β-Blockers can be used in combination with other antiHTN drugs to achieve maximal blood pressure control. Labetalol can be used in HTN emergencies and urgencies. β-Blockers may be useful in HTN patients having a hyperkinetic circulation (palpitations, tachycardia, HTN, and anxiety), migraine headache, and essential tremor...
November 2016: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/27875733/relationship-between-ambient-temperature-and-frequency-and-severity-of-cardiovascular-emergencies-a-prospective-observational-study-based-on-out-of-hospital-care-data
#9
Mario Hensel, Markus Stuhr, Daniel Geppert, Jan F Kersten, Jürgen Lorenz, Thoralf Kerner
OBJECTIVE: To test the hypothesis that more cardiovascular emergencies occur at low rather than at high temperatures under moderate climatic conditions. METHODS: 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. Temperature data were matched with the associated rescue mission data. Lowess-Regression analysis was performed to assess the relationship between the temperature and the frequency of individual cardiovascular emergencies...
February 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/27577571/situational-analysis-of-facilitators-and-barriers-to-availability-and-utilization-of-magnesium-sulfate-for-eclampsia-and-severe-preeclampsia-in-the-public-health-system-in-brazil
#10
Fátima Aparecida Lotufo, Mary Angela Parpinelli, Maria José Osis, Fernanda Garanhani Surita, Maria Laura Costa, José Guilherme Cecatti
BACKGROUND: Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system...
2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27508815/-op-7a-06-treating-hypertensive-crises-between-guidelines-and-real-world-an-anti-hypertensive-role-of-anti-anxiety-drugs
#11
M Gabba, F Salinaro, R Mussinelli, M Boldrini, A Raimondi, C Belotti, A Maggi, T Perrone, M A Bressan, S Perlini
OBJECTIVE: Current ESH Guidelines are extensively devoted to diagnosis, management and follow-up of arterial hypertension in the "chronic" setting, whereas less attention is given to the acute management of hypertensive crises, a group of potentially life-threatening complications. Moreover, epidemiological data concerning hypertensive crises are limited. DESIGN AND METHOD: During 2014, 457 consecutive patients with an initial systolic blood pressure (SBP) >170 mmHg and/or diastolic blood pressure (DBP) >110 mmHg were enrolled after being admitted to an Emergency Department (ED) serving a population of more than 50000 inhabitants, RESULTS: : Hypertensive crises represented 0...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27476847/thirty-day-readmission-and-reoperation-after-surgery-for-spinal-tumors-a-national-surgical-quality-improvement-program-analysis
#12
Aditya V Karhade, Viren S Vasudeva, Hormuzdiyar H Dasenbrock, Yi Lu, William B Gormley, Michael W Groff, John H Chi, Timothy R Smith
OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011-2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis)...
August 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27399424/145%C3%A2-unplanned-reoperation-after-craniotomy-for-tumor-a-national-surgical-quality-improvement-program-analysis
#13
Hormuzdiyar H Dasenbrock, Sandra C Yan, Vamsidhar Chavakula, William B Gormley, Timothy R Smith, Elizabeth Claus, Ian F Dunn
INTRODUCTION: Although reoperation has been utilized as a metric of quality of care, no national analysis has evaluated the rate of, reasons for, and predictors of unplanned reoperation after craniotomy for tumor. METHODS: Patients who underwent cranial tumor resection were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry (2012-2014). Multivariable logistic regression examined predictors of an unplanned cranial reoperation...
August 2016: Neurosurgery
https://www.readbyqxmd.com/read/27398370/emergency-department-use-by-people-with-hiv-in-ontario-a-population-based-cohort-study
#14
Ryan Ng, Claire E Kendall, Ann N Burchell, Ahmed M Bayoumi, Mona R Loutfy, Janet Raboud, Richard H Glazier, Sean Rourke, Tony Antoniou
BACKGROUND: Emergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV. METHODS: We conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used random-effects negative binomial regression to compare rates of emergency department use...
April 2016: CMAJ Open
https://www.readbyqxmd.com/read/27294333/characteristics-and-outcomes-of-patients-presenting-with-hypertensive-urgency-in-the-office-setting
#15
Krishna K Patel, Laura Young, Erik H Howell, Bo Hu, Gregory Rutecki, George Thomas, Michael B Rothberg
IMPORTANCE: 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. OBJECTIVES: To describe the prevalence of hypertensive urgency and the characteristics and short-term outcomes of these patients, and to determine whether referral to the hospital is associated with better outcomes than outpatient management...
July 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27083919/implementing-a-policy-and-protocol-on-managing-patients-with-hypertensive-urgencies
#16
Christine Chim, Erica Dimitropoulos, Regina Ginzburg
BACKGROUND: The use of short-acting agents, such as clonidine, for hypertensive urgency has been shown to worsen outcomes and, therefore, should be avoided in the office. OBJECTIVES: The primary objective was to achieve decreased rates of clonidine orders for immediate treatment of asymptomatic hypertension in the office. The secondary objective was to determine if reduced use leads to a decline in poor outcomes. METHODS: This was an observational cohort study evaluating a protocol and algorithm developed by clinical pharmacists on the appropriate management of hypertensive urgencies...
July 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/26877434/p-130-hypertensive-emergencies-a-nosological-entity-with-a-serious-prognosis
#17
K Adoubi, F Diby, F Sall, P Ouattara, A Gnaba, I Ouattara, H Yangni-Angate
OBJECTIFS: La présence d'une hypertension artérielle sévère au cours d'une urgence cardiovasculaire semble être un critère surajouté de mauvais pronostic. L'objectif de ce travail était d'apprécier la place et la gravité des urgences hypertensives dans le groupe des urgences cardiovasculaires. MéTHODES: Nous avons réalisé une étude décrivant et comparant les urgences hypertensives avec les autres urgences cardiovasculaires dans le Service des Urgences Médicales du CHU de Bouaké chez les patients admis entre janvier 2011 et décembre 2014...
December 2015: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/26877270/co-18-emergencies-and-hypertensive-crisis-in-an-emergency-department-evaluation-and-mortality-in-3-months
#18
H Guiga, G Sarlon Bartoli, F Silhol, W Radix, B Vaïsse
OBJECTIFS: Étudier la prévalence et la gravité des urgences et des poussées hypertensives dans un Service d'Urgence Hospitalière de CHU, et effectuer un suivi à 3 mois des patients hospitalisés. MéTHODES: Cette étude prospective a été réalisée dans le Service des Urgences entre le 1(er)(a)vril et le 31 juin 2015 : tous les patients avec une PA > 180 et/ou 110mmHg ont été comptabilisés et classés en urgences vraies (présence d'une souffrance viscérale) et en poussées hypertensives isolées...
December 2015: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/26781933/hypertensive-urgencies-and-emergencies-in-the-hospital-setting
#19
Cynthia M Cooper, Andrew Z Fenves
The prevalence of hypertension in the general population has steadily climbed over the past several decades and hypertension is a primary or secondary diagnosis in nearly a fourth of hospitalized adults. Hospitalization is often a time of pertubation in a patient's usual blood pressure control, with pain, anxiety and missed medications all risk factors for severe hypertension. Hospitalists are often faced with severe hypertension in a patient not previously known to them and this presents a challenge of how best to assess the clinical importance of blood pressure elevation...
2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/26687550/assessment-of-hypertension-control-and-clinical-course-of-patients-excluded-from-the-symplicity-htn-3-trial
#20
RANDOMIZED CONTROLLED TRIAL
Charan Yerasi, Nevin C Baker, Anil K Jonnalagadda, Rebecca Torguson, Suman Singh, Judith Vies, Ron Waksman
The screening of patients referred for the Symplicity Renal-Denervation Catheter Therapy on Resistant Hypertension (SYMPLICITY HTN-3) trial was rigorous, with many found not eligible to participate. We investigate patients who were not included in the trial and evaluate their current hypertensive (HTN) therapy, control and clinical status. A retrospective review and telephone interview was performed 8-10 months postscreening on 45 patients and their referring providers who were ultimately not included. Patients were grouped into 4 categories: (1) noninterest; (2) excluded (not meeting inclusion criteria); (3) screen failure (excluded during screening visits due to adequate blood pressure control guided by HTN specialist); or (4) referred after enrollment closure...
December 2015: Journal of the American Society of Hypertension: JASH
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