JCCVS
Journal of Cardiology & Cardiovascular Surgery

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

eISSN: 2980-1397
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Hypertensive emergency: diagnostic and therapeutic strategies
Abstract
Hypertensive emergencies are life-threatening conditions with end-organ damage caused by sudden increases in blood pressure that exceed 180/110-120 mmHg. Clinical conditions affecting the brain, arteries, retina, kidney and heart are encountered. The brain and cardiovascular system are most commonly affected. Ischemic stroke and acute pulmonary edema are the most common conditions. Some patients may experience end-organ damage independent of blood pressure values. This condition develops due to microangiopathy and deterioration of autoregulation that provides organ blood flow by damaging the vascular endothelium due to increased blood pressure. High blood pressure also increases end-organ damage in a vicious cycle by activating the renin-angiotensin-aldosterone system. This pathophysiology is important in treatment. As a general approach, rapid blood pressure reduction is not desired. Perfusion in end-organs that cannot adapt to autoregulation is impaired, and organ dysfunction deepens with ischemia and necrosis. In the general approach, a 10-20% decrease is targeted in the first hour, while a 5-15% decrease in blood pressure in the remaining 23 hours is sufficient. However, in ischemic stroke, blood pressure control is reduced according to both the treatment and the degree of pressure. If thrombolytic therapy is not to be given, if the blood pressure is not above 220/120 mmHg, no intervention is made. In aortic dissection, the aim is to reduce systolic blood pressure to 100-120 mmHg in a period of 20 minutes. In short, according to the target organ damage, short-acting intravenous antihypertensive drugs that can be treated stepwise and are selected according to the selected target values. In the selection of these drugs, options that may cause secondary damage to organ damage are avoided. Nitroprusside and nitroglycerin, which can increase central pressure, are not preferred primarily in ischemic stroke. Or, in adrenergic crisis, beta blockers can worsen blood pressure without sufficient alpha blockade. It should also be well known that such drugs have important side effects such as severe hypotension and cardiogenic shock.

Keywords : End organ damage, hypertensive emergency, treatment

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1. Kulkarni S, Glover M, Kapil V, et al . Management of hypertensivecrisis: British and Irish Hypertension Society Position document. JHum Hypertens. 2023;37(10):863-879.
2. Elliott WJ, Varon J. Evaluation and treatment of hypertensiveemergencies in adults. UpToDate (Serial online) 2024 Aug(Update 2023 June 14). Avaible from https://sso.uptodate.com/contents/evaluation-and-treatment-of-hypertensive-emergencies-in-adult ssearch=hypertensive%20emerency&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1
3. Bress AP, Anderson TS, Flack JM, et al The management of elevatedblood pressure in the acute care setting: a scientific statement from theAmerican Heart Association. Hypertension. 2024;81(8):e94-e106.
4. Kotruchin P, Tangpaisarn T, Mitsungnern T, et al. Hypertensiveemergencies in Asia: a brief review. J Clin Hypertens (Greenwich).2022;24(9):1226-1235.
5. Astarita A, Covella M, Vallelonga F, et al Hypertensive emergencies andurgencies in emergency departments: a systematic review and meta-analysis. J Hypertens. 2020;38(7):1203-1210.
6. Rossi GP, Rossitto G, Maifredini C, et al. Management of hypertensiveemergencies: a practical approach. Blood Press. 2021;30(4):208-219.
7. Janke AT, McNaughton CD, Brody AM, Welch RD, Levy PD. Trendsin the incidence of hypertensive emergencies in US emergencydepartments from 2006 to 2013.J Am Heart Assoc.2016;5(12): e004511.
8. Siddiqi TJ, Usman MS, Rashid AM, et al. Clinical outcomes inhypertensive emergency: a systematic review and meta-analysis. J AmHeart Assoc. 2023;12(14):e029355.
9. Peixoto AJ. Acute Severe Hypertension. N Engl J Med. 2019;381(19):1843-1852.
10. Figueiredo VN, Yugar-Toledo JC, Martins LC, et al. Vascular stiffnessand endothelial dysfunction: correlations at different levels of bloodpressure. Blood Press. 2012;21(1):31-38.
11. Derhaschnig U, Testori C, Riedmueller E, et al. Hypertensiveemergencies are associated with elevated markers of inflammation,coagulation, platelet activation and fibrinolysis. J Hum Hypertens.2013;27(6):368-373.
12. van den Born BJ, Löwenberg EC, van der Hoeven NV, et al. Endothelialdysfunction, platelet activation, thrombogenesis and fibrinolysis inpatients with hypertensive crisis. J Hypertens. 2011; 29(5):922-927.
13. Miller J, McNaughton C, Joyce K, et al. Hypertension management inemergency departments. Am J Hypertens. 2020;33(10):927-934.
14. Saladini F, Mancusi C, Bertacchini F, et al. Diagnosis and treatment ofhypertensive emergencies and urgencies among Italian emergency andintensive care departments. Results from an Italian survey: ProgettoGEAR (Gestione dell’Emergenza e urgenza in ARea critica). Eur JIntern Med. 2020;71:50-56.
15. Jolly H, Freel EM, Isles C. Management of hypertensive emergenciesand urgencies: narrative review. Postgraduate Med J. 2023;99(1169):119-126.
16. Mathews EP, Newton F, Kartavya S. Hypertensive Emergencies: AReview. Am J Nurs. 2021; 121(10):24-35.
17. Angeli F, Reboldi G, Verdecchia P. Hypertensive urgencies andemergencies: Misconceptions and pitfalls. Eur J Intern Med. 2020;71:15-17.
18. Filho JO, Mullen MT. Initial assessment and management of acutestroke. UpToDate (Serial online) 2024 Aug (Update 2024 Jul 11).Avaible from https://sso.uptodate.com/contents/initial-assessment-and-management-of-acute-stroke?sectionName=BLOOD%20PRESSURE%20MANAGEMENT &search=hypertensive%20emerency&topicRef=3837&anchor=H14&source=see_link#H14
19. McEvoy JW, McCarthy CP, Bruno RM, et al. ESC Guidelines for theManagement of Elevated Blood Pressure and Hypertension: Developedby the Task Force on the Management of Elevated Blood Pressureand Hypertension of the European Society of Cardiology (ESC) andEndorsed by the European Society of Endocrinology (ESE) and theEuropean Stroke Organisation (ESO). Eur Heart J. 2024;ehae178.
20. Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for theManagement of Patients With Spontaneous Intracerebral Hemorrhage:A Guideline From the American Heart Association/American StrokeAssociation. Stroke. 2022;53(7):e282-e361.
21. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA Guideline for thePrevention, Detection, Evaluation, and Management of High BloodPressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical PracticeGuidelines. J Am Coll Cardiol. 2018;71(6):1269-1324.
22. Balahura A-M, Moroi ?-I, Scafa-Udrişte A, et al. The management ofhypertensive emergencies—is there a “magical” prescription for all? JClin Med. 2022;11(11):3138.
23. Diringer MN, Bleck TP, Claude Hemphill J, et al. Critical caremanagement of patients following aneurysmal subarachnoidhemorrhage: recommendations from the Neurocritical CareSociety’s Multidisciplinary Consensus Conference. Neurocrit Care.2011;15(2):211-240.
24. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines forthe management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 1999 Guidelines for the Managementof Patients With Acute Myocardial Infarction). Circulation.2004;110(5):588-636.
25. Miller JB, Hrabec D, Krishnamoorthy V, et al. Evaluation andmanagement of hypertensive emergency. BMJ. 2024;386:e077205.
26. Talle MA, Ngarande E, Doubell AF, et al. Cardiac Complications ofHypertensive Emergency: Classification, Diagnosis and ManagementChallenges. J Cardiovasc Dev Dis. 2022;9(8):276.
27. Hiratzka LF, Bakris GL, Beckman JA, et al. American College ofCardiology Foundation/American Heart Association Task Force onPractice Guidelines, American Association for Thoracic Surgery,American College of Radiology, American Stroke Association, Societyof Cardiovascular Anesthesiologists, Society for CardiovascularAngiography and Interventions, Society of Interventional Radiology,Society of Thoracic Surgeons, Society for Vascular Medicine.Circulation. 2010;121(13):e266-369.
28. Varon J, Soto-Ruiz KM, Baumann BM, et al. The management ofacute hypertension in patients with renal dysfunction: labetalol ornicardipine? Postgrad Med. 2014;126(4):124-130.
Article available in :
Volume 2, Issue 3, 2024
Page : 56-60
https://doi.org/10.51271/JCCVS-0038
Article Information
Received : 18 Eyl 2024
Accepted : 29 Eyl 2024
Published : 30 Eyl 2024
Corresponding Author :

Ahmet Burak Erdem: Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Erdem AB, Sarcan E. Hypertensive emergency: diagnostic and therapeutic strategies. J Cardiol Cardiovasc Surg. 2024;2(3):56-60.

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