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Vadeboncoeur A, Marcil MJ, Cyr S, Gupta M, Cournoyer A, Minichiello A, Larose D, Sirois-Leclerc J, Tardif JC, Morin J, Masson V, Cossette M, Brouillette J. Trajectory of patients consulting the emergency department for high blood pressure values. CAN J EMERG MED 2022; 24:515-519. [PMID: 35503402 PMCID: PMC9345802 DOI: 10.1007/s43678-022-00307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Emergency department (ED) visits for high blood pressure are increasing in frequency. We aimed to map those patients' trajectory, from referral sources to the type of care received at the ED to anticipated actions for future high blood pressure concerns, and to better understand their reasons for consulting the ED for high blood pressure values. METHODS Between 2018 and 2020, patients who presented to the Montreal Heart Institute's ED for elevated blood pressure were recruited in a prospective observational study including a post hoc structured telephone interview and medical chart review. Five possible referral sources were predetermined. We provided proportions and 95% confidence intervals. RESULTS A total of 100 patients were recruited (female: 59%, mean age: 69 ± 12). A majority (93%, 95% CI 88-98%) possessed a home blood pressure device, among which 46% (95% CI 36-56%) remembered receiving advice for its use. The main referral sources for high blood pressure to the ED were self-reference (53%, 95% CI 43-63%), advice of a lay person (19%, 95% CI 11-27%) or a nurse (13%, 95% CI 6-20%). Mainly, patients reported being concerned by concomitant symptoms or experiencing acute medical consequences (44%, 95% CI 34-54%), having followed the recommendation of a third party (33%, 95% CI 24-42%), or having concerns about their medication (6%, 95% CI 1-11%). Two weeks following their ED visits, consulting ED remained the main choice for future concerns about high blood pressure for 27% of participants. When specifically asked if they would return to the ED for elevated blood pressure, 73% (95% CI 64-83%) said yes. CONCLUSIONS Most patients who consulted the ED for elevated blood pressure values were self-referred. More can be done to promote blood pressure education, effective use of personal blood pressure devices, and recommendations for patients and health professionals when confronted with high blood pressure results.
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Affiliation(s)
- Alain Vadeboncoeur
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Marie-Joelle Marcil
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Samuel Cyr
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada.,Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - Mona Gupta
- Centre de recherche, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Alexis Cournoyer
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Anthony Minichiello
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Dominic Larose
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Julie Sirois-Leclerc
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Jean-Claude Tardif
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Josée Morin
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Violaine Masson
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Center, Montréal, QC, Canada
| | - Judith Brouillette
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada. .,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Langlo KAR, Silva GJJ, Overrein TS, Adams V, Wisløff U, Dalen H, Rolim N, Hallan SI. Circulating microRNAs May Serve as Biomarkers for Hypertensive Emergency End-Organ Injuries and Address Underlying Pathways in an Animal Model. Front Cardiovasc Med 2021; 7:626699. [PMID: 33644125 PMCID: PMC7906971 DOI: 10.3389/fcvm.2020.626699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/31/2020] [Indexed: 11/20/2022] Open
Abstract
There is an incomplete understanding of the underlying pathophysiology in hypertensive emergencies, where severely elevated blood pressure causes acute end-organ injuries, as opposed to the long-term manifestations of chronic hypertension. Furthermore, current biomarkers are unable to detect early end-organ injuries like hypertensive encephalopathy and renal thrombotic microangiopathy. We hypothesized that circulating microRNAs (c-miRs) could identify acute and chronic complications of severe hypertension, and that combinations of c-miRs could elucidate important pathways involved. We studied the diagnostic accuracy of 145 c-miRs in Dahl salt-sensitive rats fed either a low-salt (N = 20: 0.3% NaCl) or a high-salt (N = 60: 8% NaCl) diet. Subclinical hypertensive encephalopathy and thrombotic microangiopathy were diagnosed by histopathology. In addition, heart failure with preserved ejection fraction was evaluated with echocardiography and N-terminal pro-brain natriuretic peptide; and endothelial dysfunction was studied using acetylcholine-induced aorta ring relaxation. Systolic blood pressure increased severely in animals on a high-salt diet (high-salt 205 ± 20 mm Hg vs. low-salt 152 ± 18 mm Hg, p < 0.001). Partial least squares discriminant analysis revealed 68 c-miRs discriminating between animals with and without hypertensive emergency complications. Twenty-nine c-miRs were strongly associated with hypertensive encephalopathy, 24 c-miRs with thrombotic microangiopathy, 30 c-miRs with heart failure with preserved ejection fraction, and 28 c-miRs with endothelial dysfunction. Hypertensive encephalopathy, thrombotic microangiopathy and heart failure with preserved ejection fraction were associated with deviations in many of the same c-miRs, whereas endothelial dysfunction was associated with a different set of c-miRs. Several of these c-miRs demonstrated fair to good diagnostic accuracy for a composite outcome of hypertensive encephalopathy, thrombotic microangiopathy and heart failure with preserved ejection fraction in receiver-operating-curve analyses (area-under-curve 0.75–0.88). Target prediction revealed an enrichment of genes related to several pathways relevant for cardiovascular disease (e.g., mucin type O-glycan biosynthesis, MAPK, Wnt, Hippo, and TGF-beta signaling). C-miRs could potentially serve as biomarkers of severe hypertensive end-organ injuries and elucidate important pathways involved.
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Affiliation(s)
- Knut Asbjørn Rise Langlo
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Nephrology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gustavo Jose Justo Silva
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Tina Syvertsen Overrein
- Division of Pathology and Medical Genetics, Department of Laboratory Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Volker Adams
- Department of Cardiology, Heart Center Dresden, TU Dresden, Dresden, Germany
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,School of Human Movement & Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Natale Rolim
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Ivar Hallan
- Department of Nephrology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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