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Miller JB, Hrabec D, Krishnamoorthy V, Kinni H, Brook RD. Evaluation and management of hypertensive emergency. BMJ 2024; 386:e077205. [PMID: 39059997 DOI: 10.1136/bmj-2023-077205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Hypertensive emergencies cause substantial morbidity and mortality, particularly when acute organ injury is present. Careful and effective strategies to reduce blood pressure and diminish the effects of pressure-mediated injury are essential. While the selection of specific antihypertensive medications varies little across different forms of hypertensive emergencies, the intensity of blood pressure reduction to the target pressure differs substantially. Treatment hinges on balancing the positive effects of lowering blood pressure with the potential for negative effects of organ hypoperfusion in patients with altered autoregulatory mechanisms. When patients do not have acute organ injury in addition to severe hypertension, they benefit from a conservative, outpatient approach to blood pressure management. In all cases, long term control of blood pressure is paramount to prevent recurrent hypertensive emergencies and improve overall prognosis. This review discusses the current evidence and guidelines on the evaluation and management of hypertensive emergency.
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Affiliation(s)
- Joseph B Miller
- Department of Emergency Medicine, Division of Critical Care Medicine, Henry Ford Health and Michigan State University Health Sciences, Detroit, MI, USA
| | - Daniel Hrabec
- Department of Emergency Medicine, Division of Critical Care Medicine, Henry Ford Health and Michigan State University Health Sciences, Detroit, MI, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Division of Critical Care Medicine, Duke University, Durham, NC, USA
| | - Harish Kinni
- Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
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Imburgio S, Arcidiacono A, Klei L, Oppegaard K, Johal AS, Udongwo N, Patel P, Patel M. Hypertensive Emergency During Dialysis: A Paradoxical Physiologic Response. Cureus 2024; 16:e60304. [PMID: 38883013 PMCID: PMC11177238 DOI: 10.7759/cureus.60304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Most end-stage renal disease patients experience a reduction in blood pressure during their hemodialysis session compared to predialysis. Surprisingly, a small subset of patients will experience an unusual physiological response to dialysis that results in a paradoxical increase in blood pressure. We discuss a case that involved an exaggerated elevation in blood pressure, ultimately requiring immediate cessation of dialysis and admission to the intensive care unit for intravenous treatment of a hypertensive emergency. This case serves as a framework to introduce the infrequently discussed concept of intradialytic hypertension. The underlying pathogenesis is poorly understood with multiple theoretical etiologies including activation of the renin-angiotensin-aldosterone system, imbalances in circulating levels of endothelium-derived mediators, clearance of antihypertensive medications, increased cardiac output, and changes in arterial thickness. It is important to be cognizant of this phenomenon as emerging evidence suggests that patients with any elevation in blood pressure during hemodialysis have increased rates of both short-term and long-term mortality.
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Affiliation(s)
- Steven Imburgio
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Anne Arcidiacono
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Lauren Klei
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Kylie Oppegaard
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Anmol S Johal
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ndausung Udongwo
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
- Cardiology, Morehouse School of Medicine, Atlanta, USA
| | - Palak Patel
- Cardiology, Jersey Shore University Medical Center, Neptune City, USA
| | - Mayurkumar Patel
- Nephrology, Jersey Shore University Medical Center, Neptune City, USA
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3
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Ma Y, Chen H, Li H, Zhao Z, An Q, Shi C. Targeting monoamine oxidase A: a strategy for inhibiting tumor growth with both immune checkpoint inhibitors and immune modulators. Cancer Immunol Immunother 2024; 73:48. [PMID: 38349393 PMCID: PMC10864517 DOI: 10.1007/s00262-023-03622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/22/2023] [Indexed: 02/15/2024]
Abstract
Monoamine oxidase A (MAOA) is a membrane-bound mitochondrial enzyme present in almost all vertebrate tissues that catalyzes the degradation of biogenic and dietary-derived monoamines. MAOA is known for regulating neurotransmitter metabolism and has been implicated in antitumor immune responses. In this review, we retrospect that MAOA inhibits the activities of various types of tumor-associated immune cells (such as CD8+ T cells and tumor-associated macrophages) by regulating their intracellular monoamines and metabolites. Developing novel MAOA inhibitor drugs and exploring multidrug combination strategies may enhance the efficacy of immune governance. Thus, MAOA may act as a novel immune checkpoint or immunomodulator by influencing the efficacy and effectiveness of immunotherapy. In conclusion, MAOA is a promising immune target that merits further in-depth exploration in preclinical and clinical settings.
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Affiliation(s)
- Yifan Ma
- Division of Cancer Biology, Laboratory Animal Center, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
- Gansu University of Traditional Chinese Medicine, Lanzhou, 730030, Gansu, People's Republic of China
| | - Hanmu Chen
- Division of Cancer Biology, Laboratory Animal Center, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
- School of Basic Medical Sciences, Medical College of Yan'an University, 580 Bao-Ta Street, Yanan, 716000, Shaanxi, People's Republic of China
| | - Hui Li
- Division of Cancer Biology, Laboratory Animal Center, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Zhite Zhao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Qingling An
- Division of Cancer Biology, Laboratory Animal Center, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Changhong Shi
- Division of Cancer Biology, Laboratory Animal Center, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China.
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Altuntas E, Cetın S. Fragmented QRS as a predictor of hypertensive crisis in patients with newly diagnosed essential hypertension: 4-year follow-up data. Herz 2023; 48:474-479. [PMID: 37369872 DOI: 10.1007/s00059-023-05194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/22/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Hypertensive crisis (HC) is a life-threatening condition in patients with hypertension (HT). However, there is no electrocardiography (ECG) marker that can predict which hypertensive patient may develop HC. The fragmented QRS (fQRS) complex is an important prognostic marker in ECG that might be predict cardiovascular events and mortality. Our study aimed to investigate whether fQRS can predict the development of HC in patients with HT, within 4 years of follow-up. METHODS Newly diagnosed patients with essential HT were recruited for the study from an outpatient clinic. The patients were divided into two groups according to the presence of HC: HC (+) and HC (-). During follow-up, the relationship between fQRS and HC was evaluated. RESULTS The study group included 504 patients with newly diagnosed HT. During the follow-up period, HC occurred in 98 of the patients. In 57 (11.30%) patients, fQRS was observed on ECG; fQRS was detected in the ECG of 19 (19.38%) of the HC (+) patients (p = 0.008). The results of multivariate logistic regression analysis showed that fQRS (p < 0.001) was as independent predictor for HC development. Kaplan-Meier analysis further demonstrated that the presence of fQRS affects the development of hypertensive urgency in hypertensive patients (log-rank p < 0.001). CONCLUSION In patients with newly diagnosed HT, the presence of fQRS was found to be an independent predictor of HC.
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Affiliation(s)
- Emine Altuntas
- Department of Cardiology, Sancaktepe Sehit Professor Ilhan Varank Education and Research Hospital, Istanbul, Turkey.
| | - Sükrü Cetın
- Department of Cardiology, Sancaktepe Sehit Professor Ilhan Varank Education and Research Hospital, Istanbul, Turkey
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Bereda G. Hypertensive emergency occurred due to forgetting to take antihypertensive medication: A case study. SAGE Open Med Case Rep 2023; 11:2050313X231168287. [PMID: 37113389 PMCID: PMC10126595 DOI: 10.1177/2050313x231168287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
A life-threatening condition known as a "hypertensive emergency" is marked by a severe increase in blood pressure together with acute or significant target-organ damage. On 1 June 2022, a 67-year-old black male farmer was admitted to the emergency department with a major chief complaint of breathing difficulty. The patient was traveling to the village for work and forgetting his medication at home, and he was losing consciousness and motor activity at his workplace. He presented with symptoms of shortness of breath, confusion, dizziness, nausea, vomiting, blurred vision, and faintness. An abnormal cardiac region was visible on chest X-rays, and there were no changes to the pulmonary parenchyma or fluid overload. Upon admission, hydralazine (5 mg) intravenously was administered immediately, and he was reassessed after 20 min and kept at the emergency department. The next day, sustained-release nifedipine (20 mg) was initiated orally twice a day for the patient, and he was transferred to the medical ward. In the medical ward, the patient was assessed for 4 days, and in those 4 days, he showed marked improvement. Hypertensive emergency treatment intends to reverse target-organ damage, readily lowering blood pressure, decreasing adverse clinical complications, and enhancing the quality of life.
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Affiliation(s)
- Gudisa Bereda
- Gudisa Bereda, Pharmacy Department, All
Africa Leprosy, Tuberculosis and Rehabilitation Training Centre, Zenebework,
Kolfe Keranio, Addis Ababa 182609, Ethiopia.
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Samuel N, Nigussie S, Jambo A, Dechasa M, Demeke F, Godana A, Birhanu A, Gashaw T, Agegnehu Teshome A, Siraj A. Treatment Outcome and Associated Factors Among Patients Admitted with Hypertensive Crisis in Public Hospitals at Harar Town, Eastern Ethiopia: A Cross-Sectional Study. Integr Blood Press Control 2022; 15:113-122. [PMID: 36536824 PMCID: PMC9758999 DOI: 10.2147/ibpc.s386461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/22/2022] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Hypertensive crisis is a significant global health issue that raises the costs to healthcare systems and requires specific attention to improve clinical outcome. There is scarce information on hypertensive crisis cases treatment outcome in the study setting. OBJECTIVE This study aimed to assess treatment outcome and associated factors among patients admitted with hypertensive crisis at Public Hospitals in Harar Town, Eastern Ethiopia. METHODS A cross-sectional study was conducted among 369 hypertensive crisis patients who had been admitted to the emergency department of Hiwot Fana Comprehensive Specialized Hospital and Jugol General Hospital from May 1, 2017, to May 1, 2022. All hypertensive crisis patients who fulfilled the inclusion criteria were included. The data were extracted from medical records using a data abstraction format. The collected data were analyzed using Statistical Package for Social Sciences version 22. Binary logistics regression model using bivariate and multivariable analysis with 95% confidence intervals and P-values were used to determine the association between variables. RESULTS The medical records of 369 patients in total were reviewed. Of these, the medical records of 363 patients contained all the necessary information and were used in the study. More than half of the patients (238; 65.6%) were males. Among 363 patients admitted with hypertensive crisis, 98 (27.0%, 95% Confidence Interval (CI):22.5%-31.9%) of them had poor treatment outcome of hypertensive crisis. Being female (Adjusted Odds Ratio (AOR)=3.4; 95% CI=1.7-7.9), residing in rural areas (AOR=2.4; 95% CI=2.7-5.1), taking captopril during admission (AOR=5.6; 95% CI=2.4-7.9), taking antihypertensive treatment before admission (AOR=0.5; 95% CI=0.2-0.9), and being non compliant to treatment (AOR=2.7; 95% CI=1.4-3.5) had statistically significant associations with poor treatment outcome of hypertensive crisis compared to their counterparts. CONCLUSION The magnitude of poor treatment outcome of hypertensive crisis was high. Sex, residence, non-compliance, and type of emergency drug administered during admission were substantially related with poor treatment outcome of hypertensive crisis. Health professionals should put great emphasis on emergency drugs administered during admission to achieve the desired outcome.
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Affiliation(s)
- Nahom Samuel
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Shambel Nigussie
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abera Jambo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Fekade Demeke
- Department of Epidemiology, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Abduro Godana
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amas Siraj
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Lupariello F, Mirri F, Davico L, Di Vella G. An Unexpected Death Due to a Subclinical Pheochromocytoma After an Induced Abortion. Am J Forensic Med Pathol 2022; 43:376-379. [PMID: 36377856 DOI: 10.1097/paf.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ABSTRACT Deaths due to hypertensive crisis can be unexplained because of the impossibility to identify-before the decease-the specific cause of the crisis. In these cases, autopsy and microscopic examinations are needed. It can happen that the request to conduct these examinations can be submitted to forensic pathologists by prosecutors to ascertain medical malpractice claims. Indeed, we report the case of a 36-year-old woman who died after a minimally invasive medical procedure because of the occurrence of a severe hypertensive crisis. After death, the woman's relatives raised formal complaint for medical malpractice. For this reason, the prosecutor ordered to perform an autopsy. Examining the abdominal cavity, the forensic pathologists identified the left adrenal gland as expanded; in correspondence with organ's medulla, there was a gray and noncapsulated mass. Immunohistochemistry was performed: the microscopic samples were diffusely positive for chromogranin A, suggesting the diagnosis of a subclinical pheochromocytoma. In light of the above, medical malpractice was excluded. This case highlights that forensic pathologists should be aware that, in case of unexpected deaths due to hypertensive crisis, adrenal glands should be always accurately evaluated, performing specific immunohistochemistry study to exclude the presence of a pheochromocytoma.
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Affiliation(s)
- Francesco Lupariello
- From the Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Sezione di Medicina Legale, "Università degli Studi di Torino
| | - Federica Mirri
- From the Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Sezione di Medicina Legale, "Università degli Studi di Torino
| | - Laura Davico
- Anatomia Patologica U, "A.O.U. Città della Salute e della Scienza," Torino, Italy
| | - Giancarlo Di Vella
- From the Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Sezione di Medicina Legale, "Università degli Studi di Torino
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Kim W, Kim BS, Kim HJ, Lee JH, Shin J, Shin JH. Clinical implications of cardiac troponin-I in patients with hypertensive crisis visiting the emergency department. Ann Med 2022; 54:507-515. [PMID: 35112971 PMCID: PMC8820824 DOI: 10.1080/07853890.2022.2034934] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Cardiac troponin-I (cTnI) is a representative marker of myocardial injury. Elevation of cTnI is frequently observed in patients with hypertensive crisis, but few studies have examined its prognostic significance in hypertensive crisis. We aimed to determine whether cTnI could predict all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). METHODS This observational study included patients aged ≥18 years who visited an ED between 2016 and 2019 for hypertensive crisis, defined as systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥110 mmHg. Among 6467 patients, 3938 who underwent a cTnI assay were analysed. RESULTS Among the 3938 patients, 596 (15.1%) had cTnI levels above the 99th percentile upper reference limit (elevated cTnI >40 ng/L) and 600 (15.2%) had cTnI levels between the detection limit (≥10 ng/L) and the 99th percentile upper reference limit (detectable cTnI). The 3-year all-cause mortality in the elevated, detectable and undetectable cTnI groups were 41.6%, 36.5% and 12.8%, respectively. After adjusting for confounding variables, elevated cTnI patients (adjusted hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.61-2.52) and detectable cTnI patients (adjusted HR, 1.64; 95% CI, 1.32-2.04) showed a significantly higher risk of 3-year all-cause mortality than did patients with undetectable cTnI. CONCLUSIONS In patients with hypertensive crisis, elevated cTnI levels provide useful prognostic information and permit the early identification of patients with an increased risk of death. Moreover, putatively normal but detectable cTnI levels also significantly correlated with a higher risk of all-cause mortality. Intensive treatment and follow-up strategies are needed for patients with hypertensive crisis with elevated and detectable cTnI levels.Key messagesCardiac troponin-I level was an independent prognostic factor for all-cause mortality in patients with hypertensive crisis.Detectable but normal range cardiac troponin-I, which was considered clinically insignificant, also had a prognostic impact on all-cause mortality comparable to elevated cardiac troponin-I levels.
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Affiliation(s)
- Woohyeun Kim
- Department of Internal Medicine, Division of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jun Hyeok Lee
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jinho Shin
- Department of Internal Medicine, Division of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
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Kim WD, Kim BS, Shin JH. Association of anaemia with long-term mortality among patients with hypertensive crisis in the emergency department. Ann Med 2022; 54:2752-2759. [PMID: 36205691 PMCID: PMC9553135 DOI: 10.1080/07853890.2022.2128209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Anaemia is frequent in patients with cardiovascular disease and is significantly associated with poor prognosis. However, the prognostic significance of anaemia in hypertensive crisis remains unknown. We conducted this study to determine whether anaemia is a risk factor for all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). METHODS This retrospective study included patients who visited the ED between 2016 and 2019 for hypertensive crisis, which was defined as systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg. A total of 5,512 patients whose serum haemoglobin levels were checked were included in this study and were classified into three groups according to their serum haemoglobin levels at admission to the ED: moderate/severe anaemia (haemoglobin <11 g/dL), mild anaemia (haemoglobin 11 to <13 g/dL in men and 11 to <12 g/dL in women), and non-anaemia (haemoglobin ≥13 g/dL in men and ≥12 g/dL in women). RESULTS Among 5,512 patients, 665 (12.1%) and 668 (12.1%) were classified into the moderate/severe anaemia and mild anaemia groups, respectively. The three-year all-cause mortality rates in the moderate/severe anaemia, mild anaemia, and non-anaemia groups were 46.0, 29.2, and 12.0%, respectively. After accounting for relevant covariates, patients with moderate/severe anaemia group (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.75-2.64) and mild anaemia group (HR, 1.32; 95% CI, 1.07-1.63) had a higher risk of 3-year all-cause mortality than the non-anaemia group. CONCLUSION Anaemia is independently associated with 3-year all-cause mortality in patients with hypertensive crisis. A comprehensive therapeutic approach through more in-depth examination and close follow up are required for patients with hypertensive crisis with anaemia.KEY MESSAGESAnaemia is independently associated with 3-year all-cause mortality in patients with hypertensive crisis.A comprehensive therapeutic approach through more in-depth examination and close follow up are required for patients with hypertensive crisis with anaemia.
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Affiliation(s)
- Wook-Dong Kim
- Department of Internal Medicine, Division of Cardiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Byung Sik Kim
- Department of Internal Medicine, Division of Cardiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jeong-Hun Shin
- Department of Internal Medicine, Division of Cardiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
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Edinoff AN, Swinford CR, Odisho AS, Burroughs CR, Stark CW, Raslan WA, Cornett EM, Kaye AM, Kaye AD. Clinically Relevant Drug Interactions with Monoamine Oxidase Inhibitors. Health Psychol Res 2022; 10:39576. [PMID: 36425231 PMCID: PMC9680847 DOI: 10.52965/001c.39576] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
Monoamine oxidase inhibitors (MAOI) are a class of drugs that were originally developed for the treatment of depression but have since been expanded to be used in management of affective and neurological disorders, as well as stroke and aging-related neurocognitive changes. Ranging from irreversible to reversible and selective to non-selective, these drugs target the monoamine oxidase (MAO) enzyme and prevent the oxidative deamination of various monoamines and catecholamines such as serotonin and dopamine, respectively. Tyramine is a potent releaser of norepinephrine (NE) and is found in high concentrations in foods such as aged cheeses and meats. Under normal conditions, NE is unable to accumulate to toxic levels due to the presence of MAO-A, an enzyme that degrades neurotransmitters, including NE. When MAO-A is inhibited, the capacity to handle tyramine intake from the diet is significantly reduced causing the brain to be vulnerable to overstimulation of postsynaptic adrenergic receptors with as little as 8-10 mg of tyramine ingested and can result in life-threatening blood pressure elevations. In addition to adverse reactions with certain foods, both older and newer MAOIs can negatively interact with both sympathomimetic and serotonergic drugs. In general, patients on a MAOI want to avoid two types of medications: those that can elevate blood pressure via sympathomimetic actions (e.g., phenylephrine and oxymetazoline) and those that can increase serotonin levels via 5-HT reuptake inhibition (e.g., dextromethorphan, chlorpheniramine, and brompheniramine). Illicit drugs that stimulate the central nervous system such as ecstasy (MDMA, 3,4-methylenedioxymethamphetamine) act as serotonin releasers. Patient involvement is also crucial to ensure any interaction within the healthcare setting includes making other providers aware of a MAOI prescription as well as avoiding certain OTC medications that can interact adversely with MAOIs.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital
| | - Connor R Swinford
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport
| | - Amira S Odisho
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport
| | | | - Cain W Stark
- School of Medicine, Louisiana State University Health Science Center Shreveport
| | | | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport
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11
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Irfan A, George J, Obiarinze R, Porterfield J, Barker A, Chen H, Lindeman B, Fazendin J, Reddy S. The Evolution of Peri-Operative Care in the Safe Management of Pheochromocytoma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Man PK, Cheung KL, Sangsiri N, Shek WJ, Wong KL, Chin JW, Chan TT, So RHY. Blood Pressure Measurement: From Cuff-Based to Contactless Monitoring. Healthcare (Basel) 2022; 10:healthcare10102113. [PMID: 36292560 PMCID: PMC9601911 DOI: 10.3390/healthcare10102113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/04/2022] Open
Abstract
Blood pressure (BP) determines whether a person has hypertension and offers implications as to whether he or she could be affected by cardiovascular disease. Cuff-based sphygmomanometers have traditionally provided both accuracy and reliability, but they require bulky equipment and relevant skills to obtain precise measurements. BP measurement from photoplethysmography (PPG) signals has become a promising alternative for convenient and unobtrusive BP monitoring. Moreover, the recent developments in remote photoplethysmography (rPPG) algorithms have enabled new innovations for contactless BP measurement. This paper illustrates the evolution of BP measurement techniques from the biophysical theory, through the development of contact-based BP measurement from PPG signals, and to the modern innovations of contactless BP measurement from rPPG signals. We consolidate knowledge from a diverse background of academic research to highlight the importance of multi-feature analysis for improving measurement accuracy. We conclude with the ongoing challenges, opportunities, and possible future directions in this emerging field of research.
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Affiliation(s)
- Ping-Kwan Man
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Correspondence:
| | - Kit-Leong Cheung
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Nawapon Sangsiri
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Wilfred Jin Shek
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Biomedical Sciences, King’s College London, London WC2R 2LS, UK
| | - Kwan-Long Wong
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
| | - Jing-Wei Chin
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
| | - Tsz-Tai Chan
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
| | - Richard Hau-Yue So
- PanopticAI, Hong Kong Science and Technology Parks, New Territories, Hong Kong, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
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Ashraf M, Zlochiver V, Bolton A, Allaqaband SQ, Bajwa T, Jan MF. Thirty-Day Readmission Rate Among Patients With Hypertensive Crisis: A Nationwide Analysis. Am J Hypertens 2022; 35:852-857. [PMID: 35869656 DOI: 10.1093/ajh/hpac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hypertensive crisis is a life-threatening condition, further classified as hypertensive emergency and hypertensive urgency based on the presence or absence of acute or progressive end-organ damage, respectively. Readmissions in hypertensive emergency have been studied before. We aimed to analyze 30-day readmissions using recent data and more specific ICD-10-CM coding in patients with hypertensive crisis. METHODS In a retrospective study using the National Readmission Database 2018, we collected data on 129,239 patients admitted with the principal diagnosis of hypertensive crisis. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were common causes of readmission, in-hospital mortality, resource utilization, and independent predictors of readmission. We also compared outcomes between patients with hypertensive urgency and hypertensive emergency. RESULTS Among 128,942 patients discharged alive, 13,768 (10.68%) were readmitted within 30 days; the most common cause of readmission was hypertensive crisis (19%). In-hospital mortality for readmissions (1.5%) was higher than for index admissions (0.2%, P < 0.01). Mean length of stay for readmissions was 4.5 days. The mean hospital cost associated with readmissions was $10,950, and total hospital costs were $151 million. Age <65 years and female sex were independent predictors of higher readmission rates. Subgroup analysis revealed a higher readmission rate for hypertensive emergency than hypertensive urgency (11.7% vs. 10%, P < 0.01). CONCLUSIONS All-cause 30-day readmission rates are high in patients admitted with hypertensive crisis, especially patients with hypertensive emergency. Higher in-hospital mortality and resource utilization are associated with readmission in these patients.
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Affiliation(s)
- Muddasir Ashraf
- Hospital Medicine, UnityPoint Health Clinic Quad Cities, Rock Island, Illinois, USA.,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Viviana Zlochiver
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
| | - Alexander Bolton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Hospital Medicine, UnityPoint Health-St. Luke's Hospital, Cedar Rapids, Iowa, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Beeston D, Jepson R, Cortellini S. Evaluation of presentation, treatment and outcome in hypertensive emergency in dogs and cats: 15 cases (2003-2019). J Small Anim Pract 2022; 63:784-791. [PMID: 35811381 PMCID: PMC9796549 DOI: 10.1111/jsap.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Hypertensive emergency is well recognised in human medicine, yet there is limited veterinary evidence. This study aimed to determine the presentation, treatment and outcome in dogs and cats with hypertensive emergency. MATERIALS AND METHODS A retrospective case series of dogs and cats with hypertensive emergency identified as follows: acute history with non-invasive Doppler systolic blood pressure greater than 180 mmHg and target organ damage including acute onset seizures, altered mentation with or without lateral recumbency or blindness. Data collected included signalment, history, physical examination and clinicopathological findings, systolic blood pressure, antihypertensive treatment and outcome. RESULTS Seven dogs and eight cats were included presenting with seizures (n=9), blindness (n=4), altered mentation with (n=2) or without (n=2) lateral recumbency. Median age was 9 years (range 1 to 15) and duration of clinical signs before presentation was 1.5 days (range 1 to 15). Median systolic blood pressure on presentation was 230 mmHg (range 190 to 300). Amlodipine was the most common first-line agent (n=10), followed by hydralazine (n=4) and hypertonic saline (n=1). Aetiology of hypertensive emergency was acute kidney injury (n=9), idiopathic hypertension (n=3), hyperthyroidism (n=1), lymphoma (n=1) and suspected cutaneous and renal glomerular vasculopathy (n=1). Five cats and three dogs survived to discharge with an overall survival of 53.3%. CLINICAL SIGNIFICANCE Hypertensive emergencies had various presenting signs in this series. AKI was considered to be the cause of hypertension in the majority of patients. Further evaluation of treatment for hypertensive emergencies is warranted, considering almost half of the cases did not survive to discharge.
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Affiliation(s)
- D. Beeston
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
| | - R. Jepson
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
| | - S. Cortellini
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
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15
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Yizengaw MA, Chemeda K, Kumela K, Tesfaye BT. In‐hospital outcomes of patients with a hypertensive emergency at a medical center, Ethiopia: A prospective observational study. Health Sci Rep 2022; 5:e845. [PMID: 36189406 PMCID: PMC9498224 DOI: 10.1002/hsr2.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hypertensive emergency is associated with substantial complications and loss of life across the world. Early identification and treatment of hypertensive emergency complications are critical to prevent or avoid any consequences. Despite this, in Ethiopia, studies addressing mortality rate and its predictors as well as complications of hypertensive emergency are limited. Aims This study aim to evaluate in‐hospital mortality of patients admitted with a hypertensive emergency at the emergency ward of Jimma Medical Center. Methods A consecutive sample of 140 adult (≥18 years of age) patients with a hypertensive emergency were recruited from September 1, 2020 to February 25, 2021 at Jimma Medical Center, Ethiopia and were followed up from admission to discharge/death. Patients who declined to participate and readmitted during the study period were excluded. To assess factors associated with in‐hospital mortality, bivariate and multivariate Cox regression analyses were performed. A p value of less than 0.05 was used to declare the statistical significance. Results Over three‐fourths of the study participants, that is, 108 (77.1%), were males with a mean (±standard deviation) age of 52.8 ± 13.6 years. Hemorrhagic stroke, 53 (38.0%), and acute kidney injury, 38 (27.1%), were the most common complications of hypertensive emergency. The average (±standard deviation) length of stay in the hospital was 8.53 ± 3.61 days. During in‐hospital follow‐up, 16 patients (11.4%, 95% confidence interval: 6.7–17.9) died. Multivariate Cox regression analysis showed that there was a significant relationship between patients not doing regular physical exercise before the current admission (adjusted hazard ratio = 4.629, 95% confidence interval: 1.171–18.294, p = 0.015) and in‐hospital mortality. Conclusion More than one‐tenth of patients with hypertensive emergency death was recorded at Jimma Medical Center. The frequent complications of hypertensive emergency were hemorrhagic stroke and acute renal injury. Not doing regular physical exercise before the current admission raises the likelihood of in‐hospital death. Therefore, strengthening and encouraging patients to perform regular physical exercise is imperative.
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Affiliation(s)
- Mengist Awoke Yizengaw
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health Jimma University Jimma Ethiopia
| | - Kisi Chemeda
- Department of Pharmacy Jimma Medical Center Jimma Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health Jimma University Jimma Ethiopia
| | - Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health Jimma University Jimma Ethiopia
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Srivastava S, Vemulapalli B, Okoh AK, Kassotis J. Disparity in hospital admissions and length of stay based on income status for emergency department hypertensive crisis visits. J Hypertens 2022; 40:1607-1613. [PMID: 35788558 PMCID: PMC10024970 DOI: 10.1097/hjh.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Racial, gender, and socioeconomic status have been shown to impact the delivery of care. How this impacts the management of hypertensive crisis remains unclear. We aim to identify disparities on admission frequency and length of stay (LOS) among those presenting with hypertensive crisis, as a function of household income. METHODS This is a cross-sectional analysis of 2016 emergency department visits and supplemental inpatient data from the Nationwide Emergency Department Sample. Median household income quartiles were established. A multivariable logistic regression model was used to estimate odds of admission in each income quartile. A multivariable linear regression model was used to predict LOS. RESULTS After applying sample weighting, the total number of emergency department visits was 33 727 with 6906, 25 443, and 1378 visits for hypertensive emergency, hypertensive urgency, and unspecified crisis, respectively. There were 13 191, 8889, 6400, 5247 visits in the (first) lowest, second, third , and fourth (highest) income quartiles, respectively. The median age for the study population was 60. The most common comorbidity was chronic kidney disease. Individuals with the highest income, had a lower likelihood of admission, compared with the lowest quartile (adjusted odds ratio: 0.41, 95% CI 0.22-0.74). There was a significant association between income quartile and LOS among hypertensive emergency patients (beta coefficient: 0.407, P value = 0.019). CONCLUSION In this study, patients with lower income were more likely to be admitted, whereas those with higher income exhibited a longer LOS. Clinicians must be made aware these disparities to ensure equitable delivery of care.
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Affiliation(s)
- Shreya Srivastava
- Division of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bhargav Vemulapalli
- Division of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Alexis K. Okoh
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - John Kassotis
- Division of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Palmer J, Gelmann D, Engelbrecht-Wiggans E, Hollis G, Hart E, Ali A, Haase DJ, Tran Q. Invasive arterial blood pressure monitoring may aid in the medical management of hypertensive patients with acute aortic disease. Am J Emerg Med 2022; 59:85-93. [DOI: 10.1016/j.ajem.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/17/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022] Open
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18
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Epidemiology and outcomes of hypertensive crisis in patients with chronic kidney disease: a nationwide analysis. J Hypertens 2022; 40:1288-1293. [PMID: 35703297 DOI: 10.1097/hjh.0000000000003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology and outcomes of hypertensive crisis (HTN-C) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have not been well studied. The objective of our study is to describe the incidence, clinical characteristics, and outcomes of emergency department (ED) visits for HTN-C in patients with CKD and ESRD. METHODS We performed a secondary analysis of Nationwide Emergency Department Sample databases for years 2016-2018 by identifying adult patients presenting to ED with hypertension related conditions as primary diagnosis using appropriate diagnosis codes. RESULTS There were 348 million adult ED visits during the study period. Of these, 680 333 (0.2%) ED visits were for HTN-C. Out of these, majority were in patients without renal dysfunction (82%), with 11.4 and 6.6% were in patients with CKD and ESRD, respectively. The CKD and ESRD groups had significantly higher percentages of hypertensive emergency (HTN-E) presentation than in the No-CKD group (38.9, 34.2 and 22.4%, respectively; P < 0.001). ED visits for HTN-C frequently resulted in hospital admission and these were significantly higher in patients with CKD and ESRD than in No-CKD (78.3 vs. 72.6 vs. 44.7%; P < 0.0001). In-hospital mortality was overall low but was higher in CKD and ESRD than in No-CKD group (0.3 vs. 0.2 vs. 0.1%; P < 0.0001), as was cost of care (USD 28 534, USD 29 465 and USD 26 394, respectively; P < 0.001). CONCLUSION HTN-C constitutes a significant burden on patients with CKD and ESRD compared with those without CKD with a higher proportion of ED visits, incidence of HTN-E, hospitalization rate, in-hospital mortality and cost of care. GRAPHICAL ABSTRACT http://links.lww.com/HJH/C22.
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Balik V, Šulla I. Autonomic Dysreflexia following Spinal Cord Injury. Asian J Neurosurg 2022; 17:165-172. [PMID: 36120615 PMCID: PMC9473833 DOI: 10.1055/s-0042-1751080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
AbstractAutonomic dysreflexia (AD) is a potentially life-threatening condition of the autonomic nervous system following spinal cord injury at or above T6. One of the most common symptoms is a sudden increase in blood pressure induced by afferent sensory stimulation owing to unmodulated reflex sympathetic hyperactivity. Such episodes of high blood pressure might be associated with a high risk of cerebral or retinal hemorrhage, seizures, heart failure, or pulmonary edema. In-depth knowledge is, therefore, crucial for the proper management of the AD, especially for spine surgeons, who encounter these patients quite often in their clinical practice. Systematical review of the literature dealing with strategies to prevent and manage this challenging condition was done by two independent reviewers. Studies that failed to assess primary (prevention, treatment strategies and management) and secondary outcomes (clinical symptomatology, presentation) were excluded. A bibliographical search revealed 85 eligible studies that provide a variety of preventive and treatment measures for the subjects affected by AD. As these measures are predominantly based on noncontrolled trials, long-term prospectively controlled multicenter studies are warranted to validate these preventive and therapeutic proposals.
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Affiliation(s)
- Vladimír Balik
- Department of Neurosurgery, Svet Zdravia Hospital, Michalovce, Slovakia
| | - Igor Šulla
- Department of Anatomy, University of Veterinary Medicine and Pharmacy, Histology and Physiology, Košice, Slovakia
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Debbarma M, Kohli P, Banushree R, Sen S, Kumar J, Babu N, Ramasamy K. Is perioperative blood pressure monitoring during intravitreal injections important? Ther Adv Ophthalmol 2022; 14:25158414221090103. [PMID: 35464344 PMCID: PMC9019388 DOI: 10.1177/25158414221090103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Anti-vascular endothelial growth factor intravitreal injections (IVIs) have proved to be a boon for patients suffering from several retinal pathologies. They are one of the most commonly performed procedures in ophthalmology. A perioperative rise in blood pressure (BP) has been noted during cataract surgery. Objectives: To evaluate the perioperative BP changes during IVI, and the associated risk factors. Design: Cross-sectional observational study Methods: The patients undergoing IVI from May 2019 to August 2019 were evaluated. All the patients underwent BP measurement before, during, and 1 h after the IVI. The correlation between the demographics and, the systemic comorbidities of the patients, and the ocular condition for which IVI was given was evaluated. Results: The study included 302 patients (mean age of 59.9 ± 10.7 years). The mean increase in systolic BP (SBP) and diastolic BP (DBP) at the time of injection was 25.7 ± 21.0 and 1.3 ± 13.4 mmHg, respectively. A ⩾ 10, ⩾ 20, ⩾ 30 mmHg increase in SBP at the time of injection was seen in 83.8% (n = 253), 69.5% (n = 210) and 49.0% (n = 148) patients, respectively. Forty-one (13.6%) patients developed intra-procedural hypertensive urgency, out of which six patients (14.6%) did not recover even after 1 h of the procedure. None of the patients experienced any cardiovascular events. The univariate and multivariate linear regression analyses showed that the change in intra-procedural SBP correlated positively with the age of the patient and negatively with the baseline SBP. Conclusion: There is a significant rise of SBP at the time of IVI, especially in patients with advanced age and high baseline SBP. Some of the patients can experience hypertensive urgency at the time of injection and may take more than 1 h to recover. The patients receiving IVI should undergo a detailed physician evaluation before the procedure.
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Affiliation(s)
- Meri Debbarma
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai 625020, Tamil Nadu, India
| | - R. Banushree
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai, India
| | - Sagnik Sen
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai, India
| | - Jayant Kumar
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai, India
| | - Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai, India
| | - Kim Ramasamy
- Department of Vitreo-Retinal Services, Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology, Madurai, India
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Koracevic G, Stojanovic M, Lovic D, Radovanovic RV, Koracevic M. Rationale for the Concept of Impending Hypertension-Mediated Organ Damage. Curr Vasc Pharmacol 2022; 20:127-133. [DOI: 10.2174/1570161120666220124105846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/13/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022]
Abstract
Background:
The number of patients with hypertension urgencies (HTN-Us) and emergencies (HTN-Es) in the emergency department is relatively constant despite improved detection, awareness and control of arterial hypertension.
Objective:
This study analyses the precision of the often-used definition of HTN-E, particularly the phrase ‘with the evidence of impending or progressive hypertension-mediated organ damage (HMOD)’. We then provide a rationale for the concept of impending HMOD.
MethodS:
We searched PubMed, Science Direct, Springer, Oxford Press, Wiley, SAGE and Google Scholar and analysed the relevant definition.
Results:
The definition of HTN-E is suboptimal and requires a consensus on whether to include the phrase ‘impending hypertensive HMOD’ in the definition.
Conclusion:
A consensus on the principles of treating the ‘impending hypertensive HMOD’ does not exist, making its use inconsistent in emergency departments worldwide. In this paper, we present a rationale for the concept of ‘impending HMOD’.
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, University Clinical Centre Nis, Serbia
| | | | - Dragan Lovic
- Clinic for Internal Diseases Inter Medica, Nis, Serbia
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22
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Liu SB, Yang ST. Cardiovascular protective properties of gastrodin. Asian Pac J Trop Biomed 2022. [DOI: 10.4103/2221-1691.340558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Jia S, Wu Y, Wang W, Lin W, Chen Y, Zhang H, Xia S, Zhou H. An Exploratory Study on the Relationship between Brachial Arterial Blood Flow and Cardiac Output. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1251199. [PMID: 34976321 PMCID: PMC8718296 DOI: 10.1155/2021/1251199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 01/16/2023]
Abstract
Background We have obtained prospective clinical outcomes using the brachial artery largely, such as Korotkoff sound and vasomotor function measurement by ultrasound guidance to predict the prognosis of cardiovascular diseases. Very few reports on the quantitative measurement of the relationship between the brachial artery blood flow and cardiac output have been reported. Purpose (1) To investigate whether the quantitative relationship between the brachial artery blood flow and cardiac output existed. (2) To provide a theoretical basis for taking advantage of artificial intelligence (AI) using Korotkoff sound analogously as far as possible to predict the cardiac output. Methods A total of 586 patients who underwent cardiac color ultrasound in our center from 2021.3 to 2021.7 were included for analyses. The vascular parameters of the right upper limb brachial artery (such as the Diameter, Area, Blood Velocity, and Flow) were measured immediately after the cardiac color ultrasound, and some basic clinical parameters (Age, Sex, BMI, and Disease) were recorded subsequently. Ultimately, the Mann-Whitney and independent sample T-test were used to analyze the data. Results (1) The mean Rate of the brachial arterial blood flow to cardiac output was 1.23%, and the mean 95% CI was (1.18%, 1.29%), indicating that the value was mainly concentrated in the current value interval. The indicator demonstrates that there is no significant difference currently among the patients with hypertension, coronary heart disease, and cardiac dysfunction. (2) The brachial artery wall diameter (Dist) is significantly thicker in patients with coronary heart disease and hypertension compared to patients with other cardiovascular diseases. (3) Cardiac output augments remarkably in patients with hypertension. Conclusion Our study suggests that the Rate (brachial artery blood flow/cardiac output) is a constant of 1.23% approximately. It provides a theoretical basis for the subsequent application of the artificial intelligence (AI) method to predict heart function using Korotkoff sound, cope with large computational amounts, and improve computational speed. It is also indirectly proved that hypertension can lead to a change in peripheral vascular hyperplasia and increase cardiac output.
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Affiliation(s)
- Sixiang Jia
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu 322000, China
| | - Yiteng Wu
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu 322000, China
| | - Wei Wang
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu 322000, China
| | - Wenting Lin
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu 322000, China
| | - Yiwen Chen
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu 322000, China
| | - Huanyu Zhang
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310000, China
| | - Shudong Xia
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu 322000, China
| | - Hong Zhou
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310000, China
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Xie L, Qi H, Cao F, Shen L, Chen S, Wu Y, Huang T, Song Z, Fan W. Comparison between surgery and thermal ablation for adrenal metastases: a retrospective study. Int J Hyperthermia 2021; 38:1541-1547. [PMID: 34727828 DOI: 10.1080/02656736.2021.1993356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To retrospectively compare the efficacy and safety of surgical resection (SR) and thermal ablation for the treatment of adrenal metastases. METHODS From January 2008 to December 2018, 133 patients with adrenal metastases who underwent SR (n = 76) or thermal ablation (n = 57) were enrolled. The mean tumor size was 58.00 ± 10.65 mm (22-80 mm) in the SR group and 58.03 ± 12.76 mm (34-89 mm) in the thermal ablation group. Local progression-free survival (LPFS) and safety were compared between the two groups using the Kaplan-Meier method and log-rank tests. Cox proportional hazard regression models were used to evaluate the prognostic factors of LPFS. Complications, hospitalization days, and blood loss were also assessed. RESULTS The median follow-up was 29.0 months (range, 20.4-37.6 months). No treatment-related mortality was observed. The 1-, 3- and 5-year LPFS rates were 74.0%, 62.8%, and 31.4% in the SR group and 72.8%, 68.7%, and 51.5% in the ablation group, with the median LPFS of 41.5 months (95% CI: 9.3-23.4 months) vs. 47.9 months (95% CI 20.6-75.8 months), respectively (p = 0.784). Tumor size ≥3 cm was the only significant risk factor for LPFS (p = 0.031). The ablation group was superior to the SR group with a lower major complication rate (4.1% vs. 14.5%, p = 0.03), less blood loss (1 ml vs. 100 ml, p < 0.001), and a shorter hospital stay (2 d vs. 6 d, p < 0.001). CONCLUSION Thermal ablation provided a similar LPFS and less comorbidities than SR, indicating that it is an effective and safe treatment for adrenal metastases.
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Affiliation(s)
- Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ze Song
- The Oncology Department, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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Badawy M, Gaballah AH, Ganeshan D, Abdelalziz A, Remer EM, Alsabbagh M, Westphalen A, Siddiqui MA, Taffel MT, Itani M, Shaaban AM, Elsayes KM. Adrenal hemorrhage and hemorrhagic masses; diagnostic workup and imaging findings. Br J Radiol 2021; 94:20210753. [PMID: 34464549 DOI: 10.1259/bjr.20210753] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms. Other reported less common causes of AH are COVID-19 and neonatal stress. Clinical diagnosis of AH is challenging due to its non-specific presentation and occurrence in the setting of acute medical illness. Therefore, most cases are diagnosed incidentally on imaging. Having high clinical suspicion in the proper clinical setting for AH is crucial to avoid life-threatening adrenal insufficiency that occurs in 16-50% of patients with bilateral AH. We discuss the clinical situations that predispose to AH, review the imaging features on different imaging modalities, highlight a variety of clinical cases, imaging features that should be concerning for an underlying neoplasm, and outline the potential role of interventional radiology in management of AH.
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Affiliation(s)
- Mohamed Badawy
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ayman H Gaballah
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | | | - Amr Abdelalziz
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | - Erick M Remer
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Mustafa Alsabbagh
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | - Antonio Westphalen
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Mohammed A Siddiqui
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | - Myles T Taffel
- Department of Radiology, NYU Langone Medical Center, New York, NY, United States
| | - Malak Itani
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Akram M Shaaban
- Department of Diagnostic Imaging, University of Utah, Salt Lake City, UT, United States
| | - Khaled M Elsayes
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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26
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Lin YT, Liu YH, Hsiao YL, Chiang HY, Chen PS, Chang SN, Tsai HC, Chen CH, Kuo CC. Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department. PLoS One 2021; 16:e0251311. [PMID: 34403407 PMCID: PMC8370605 DOI: 10.1371/journal.pone.0251311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
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Affiliation(s)
- Yu-Ting Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Hung Liu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Tsai
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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27
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Miguet M, Olivo G, Ciuculete DM, Elmståhl S, Lind L, Schiöth HB. Perceived stress is related to lower blood pressure in a Swedish cohort. Scand J Public Health 2021:14034948211030352. [PMID: 34282685 DOI: 10.1177/14034948211030352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS General psychosocial stress and job strain have been related to blood pressure (BP) with conflicting results. This study sought to explore the contribution of several lifestyle factors in the relation between general psychosocial stress, job strain and BP. METHODS This cross-sectional study investigated the association of general stress and job strain with systolic BP (SBP) and diastolic BP in a sample of 9441 employed individuals from the EpiHealth cohort. General stress was measured by the Perceived Stress Scale. Job strain was assessed with the Job Content Questionnaire, assessing two dimensions of job strain: psychological job demand and decision latitude. Linear regression and sensitivity analysis were performed. RESULTS At the uncorrected model, general stress, job demand and decision latitude were all inversely associated with SBP. After further adjustment for lifestyle and health parameters, only general stress was associated with SPB (β coefficient: -0.103; 95% confidence interval -0.182 to 0.023). CONCLUSIONS General stress is associated with lower SBP independently of lifestyle in middle-aged adults. Our findings point towards a major contribution for job-unrelated stressors in determining SBP and support the pivotal role of lifestyle behaviours and health status in modulating the effect of stress on BP, calling for a careful selection of confounders.
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Affiliation(s)
- Maud Miguet
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Sweden
| | - Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Sweden
| | | | | | - Lars Lind
- Uppsala Clinical Research Center (UCR), Sweden.,Department of Medical Sciences, Uppsala University, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Sweden.,Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Russia
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28
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Su HF, Shaker S, Kuang Y, Zhang M, Ye M, Qiao X. Phytochemistry and cardiovascular protective effects of Huang-Qi (Astragali Radix). Med Res Rev 2021; 41:1999-2038. [PMID: 33464616 DOI: 10.1002/med.21785] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022]
Abstract
Huang-Qi (Astragali Radix) is an herbal tonic widely used in China and many other countries. It is derived from the roots of Astragalus membranaceus and A. membranaceus var. mongholicus and shows potent cardiovascular protective effects. In this article, we comprehensively reviewed 189 small molecules isolated from the two Astragalus species and discussed the interspecies chemical differences. Moreover, we summarized the pharmacological activities and mechanisms of action of Huang-Qi and its major bioactive compounds for the treatment of cardiovascular diseases. This review covers 171 references published between February 1983 and March 2020.
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Affiliation(s)
- Hui-Fei Su
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Sharpkate Shaker
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yi Kuang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Meng Zhang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Min Ye
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Xue Qiao
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
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Wang J, McDonagh DL, Meng L. Calcium Channel Blockers in Acute Care: The Links and Missing Links Between Hemodynamic Effects and Outcome Evidence. Am J Cardiovasc Drugs 2021; 21:35-49. [PMID: 32410171 DOI: 10.1007/s40256-020-00410-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Calcium channel blockers (CCBs) exert profound hemodynamic effects via blockage of calcium flux through voltage-gated calcium channels. CCBs are widely used in acute care to treat concerning, debilitating, or life-threatening hemodynamic changes in many patients. The overall literature suggests that, for systemic hemodynamics, although CCBs decrease blood pressure, they normally increase cardiac output; for regional hemodynamics, although they impair pressure autoregulation, they normally increase organ blood flow and tissue oxygenation. In acute care, CCBs exert therapeutic efficacy or improve outcomes in patients with aneurysmal subarachnoid hemorrhage, acute myocardial infarction and unstable angina, hypertensive crisis, perioperative hypertension, and atrial tachyarrhythmia. However, despite the clear links, there are missing links between the known hemodynamic effects and the reported outcome evidence, suggesting that further studies are needed for clarification. In this narrative review, we aim to discuss the hemodynamic effects and outcome evidence for CCBs, the links and missing links between these two domains, and the directions that merit future investigations.
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Affiliation(s)
- Jin Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - David L McDonagh
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, 330 Cedar Street, TMP 3, New Haven, CT, 06520, USA.
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Hussain A, Mahmood F, Arshad MS, Abbas N, Qamar N, Mudassir J, Farhaj S, Nirwan JS, Ghori MU. Personalised 3D Printed Fast-Dissolving Tablets for Managing Hypertensive Crisis: In-Vitro/In-Vivo Studies. Polymers (Basel) 2020; 12:E3057. [PMID: 33419348 PMCID: PMC7765967 DOI: 10.3390/polym12123057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hypertensive crisis (HC) is an emergency health condition which requires an effective management strategy. Over the years, various researchers have developed captopril based fast-dissolving formulations to manage HC; however, primarily, the question of personalisation remains unaddressed. Moreover, commercially these formulations are available as in fixed-dose combinations or strengths, so the titration of dose according to patient's prerequisite is challenging to achieve. The recent emergence of 3D printing technologies has given pharmaceutical scientists a way forward to develop personalised medicines keeping in view patients individual needs. The current project, therefore, is aimed at addressing the limitations as mentioned above by developing fast-dissolving captopril tablets using 3D printing approach. Captopril unloaded (F1) and loaded (F2-F4) filaments were successfully produced with an acceptable drug loading and mechanical properties. Various captopril formulations (F2-F4) were successfully printed using fused deposition modelling technique. The results revealed that the formulations (F2 and F3) containing superdisintegrant had a faster extent of dissolution and in-vivo findings were endorsing these results. The present study has successfully exhibited the utilisation of additive manufacturing approach to mend the gap of personalisation and manufacturing fast-dissolving captopril 3D printed tablets. The procedure adopted in the present study may be used for the development of fused deposition modelling (FDM) based fast-dissolving 3D printed tablets.
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Affiliation(s)
- Amjad Hussain
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Faisal Mahmood
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Muhammad Sohail Arshad
- Department of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (M.S.A.); (J.M.)
| | - Nasir Abbas
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Nadia Qamar
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Jahanzeb Mudassir
- Department of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (M.S.A.); (J.M.)
| | - Samia Farhaj
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (S.F.); (J.S.N.)
| | - Jorabar Singh Nirwan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (S.F.); (J.S.N.)
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (S.F.); (J.S.N.)
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Anitha A, Babu K. A 10-year Study: Renal Outcomes in Patients with Accelerated Hypertension and Renal Dysfunction. Indian J Nephrol 2020; 30:409-415. [PMID: 33840961 PMCID: PMC8023030 DOI: 10.4103/ijn.ijn_332_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/27/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Hypertension is prevalent in 35%–46% of the general population; 1% of them experience accelerated hypertension. Among patients with accelerated hypertension, acute worsening of renal functions occur in 22%-55%. Morbidity and mortality rates are high. Partial renal recovery is seen in some, while others rapidly progress to end-stage renal disease. Methods: Patients who presented with accelerated hypertension, renal dysfunction, and had undergone renal biopsy were evaluated and their clinical profile was analyzed. Those who became dialysis dependent were excluded from further follow-up. Study outcome were blood pressure control, renal functions, requirement of renal replacement and mortality. Results: Of the 30 patients evaluated, age at presentation was 41.2 ± 15.46 years and 26 (86.7%) were males, 10 (33%) had presented with nonspecific complaints. Mean duration of hypertension and blood pressure were 21.93 months and 196 ± 20.8/129 ± 12.4 mmHg, respectively. Glomerulonephritis and hypertensive nephrosclerosis had similar characteristics except proteinuria (P = 0.04). Average follow-up (n = 25) duration was 3.69 years (range: 0.05–9.6). At the end of study, 6 were dialysis dependent, while in others, mean e-GFR was 23.96 ml/min/1.73 m2. Poor renal prognosis was predicted by glomerulonephritis (relative risk-4.6) and degree of interstitial fibrosis. Five-year patient and renal survival were 94.4% and 71.9%, respectively. Conclusion: Accelerated hypertension occurs among patients with both primary and secondary hypertension. It leaves permanent renal sequelae. Though some patients recover renal function partially, further progression is rapid, especially among those with chronic glomerulonephritis.
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Affiliation(s)
- Aleya Anitha
- Department of Nephrology; Apollo Hospital, Jayanagar, Bengaluru, Karnataka, India
| | - Kishore Babu
- Department of Nephrology, Manipal Hospital, Old HAL Airport Road, Bengaluru, Karnataka, India
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Gebresillassie BM, Debay YB. Characteristics, treatment, and outcome of patients with hypertensive crisis admitted to University of Gondar Specialized Hospital, northwest Ethiopia: A cross-sectional study. J Clin Hypertens (Greenwich) 2020; 22:2343-2353. [PMID: 32966697 DOI: 10.1111/jch.14056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
Despite major public health initiatives are working in the control of hypertension, hypertensive crisis remains an important clinical problem. This study aimed at examining the characteristics, treatment and outcome of patients with hypertensive crisis admitted to the University of Gondar Specialized Hospital, Ethiopia. A cross-sectional study was conducted on patient medical records (n = 304) between January 01, 2013 and December 31, 2017. Data were analyzed using Statistical Package for Social Sciences version21. A total of 252 patient medical records were included in the analysis. The mean age of the entire patients was 54 ± 17 years. Two hundred and nineteen (86.9%) patients have a documented history of hypertension and on antihypertensive drugs (n = 166, 65.9%). The majority of cases (n = 166, 65.9%) were hypertensive urgencies. In more than one-third of the patients (n = 98, 38.9%), the cause of the illness was attributed to non-compliance to therapy. The most common presenting signs and symptoms at admission were headache (n = 170, 67.5%), dyspnea (n = 36, 14.3%), and vomiting (n = 33, 13.1%). Of 852 tests ordered, the results of one-third (n = 298,34.9%) were abnormal. Nearly two-thirds (n = 336, 59.2%) of prescriptions documented were for hypertensive urgency. Captopril (n = 136, 23.9%) and hydralazine (n = 43, 7.6%) were the most commonly prescribed oral and intravenous drugs respectively. Ten patients died during 55 hours of hospital stay. All hospital mortalities were documented for a hypertensive emergency. The median decrement of diastolic blood pressure among patients with no history of previous admission and hypertensive urgency was significantly higher than those patients with a previous history of admission (P = .005) and hypertensive emergency (P = .010). These findings justify better treatment and follow-up for these patients. Most importantly, to improve compliance with treatment health professionals should provide education to the patients.
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Affiliation(s)
- Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yabsira Belayneh Debay
- Department of Pharmacy, Nordic Medical Centre As Ethiopian Branch, Addis Ababa, Ethiopia
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Desta DM, Wondafrash DZ, Tsadik AG, Kasahun GG, Tassew S, Gebrehiwot T, Asgedom SW. Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study. Integr Blood Press Control 2020; 13:95-102. [PMID: 32904390 PMCID: PMC7455594 DOI: 10.2147/ibpc.s265183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hypertensive emergency (HE) is an acute stage of uncontrolled blood pressure which poses a substantial cardiovascular morbidity and mortality in developing countries. In our setting, the prevalence of HE and the characteristics of patients with a hypertensive crisis are not certainly known yet. Objective The study assessed the prevalence of hypertensive emergency and associated factors among hospitalized patients with hypertensive crisis. Methods A retrospective cross-sectional study was conducted by reviewing records of patients having a diagnosis of hypertensive crisis with systolic/diastolic blood pressure raised to more than 180/120 mmHg admitted to Ayder Comprehensive Specialized Hospital (ACSH) from September 2018 to August 2019. Patients' medical records with complete information were enrolled consecutively. Socio-demographic, clinical characteristics, and other related variables were collected using a structured data collection tool from patient medical records. Data were entered and analyzed using SPSS version 20. Logistic regression was employed to determine factors associated with HE. Results A total of 141 patients' records with a diagnosis of a hypertensive crisis were enrolled in the study; the majority were females 77 (54.6%) and residing in the urban setting 104 (73.8%). The mean age of the participants was 58.8 years. HE was found in 42 (29.8%) of patients. Intravenous Hydralazine 39 (27.7%) and oral calcium channel blocker 102 (72.3%) were the prescribed drugs for acute blood pressure reduction in the emergency setting. Surprisingly, patients who had no history of hypertension (adjusted odds ratio (AOR)=2.469; 95% confidence interval (CI): 0.176‒0.933) and female sex (AOR=2.494; 95% CI: 1.111‒5.596) were found to be independently associated factors with HE. Conclusion The prevalence of HE was found to account a significant proportion of patients. Hence, hypertensive patients should be strictly managed accordingly, and promoting screening programs could reduce the risk of target organ damage.
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Affiliation(s)
- Desilu Mahari Desta
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Dawit Zewdu Wondafrash
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Afewerki Gebremeskel Tsadik
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Segen Tassew
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Teklu Gebrehiwot
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Terheyden JH, Wintergerst MWM, Pizarro C, Pfau M, Turski GN, Holz FG, Finger RP. Retinal and Choroidal Capillary Perfusion Are Reduced in Hypertensive Crisis Irrespective of Retinopathy. Transl Vis Sci Technol 2020; 9:42. [PMID: 32855888 PMCID: PMC7422770 DOI: 10.1167/tvst.9.8.42] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Hypertensive crisis causes end-organ damage through small-vessel damage as described histologically. Noninvasive optical coherence tomography angiography (OCTA) makes it possible to image retinal and choroidal capillaries on a microscopic level in vivo. We quantified eye vessel perfusion changes in hypertensive crisis using OCTA. Methods Patients with hypertensive crisis (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) and age-matched healthy controls were included in the study. OCTA en face 3 × 3-mm images of the superficial and deep retinal layers and the choriocapillaris were acquired. Outcome parameters included vessel density (VD) and vessel skeleton density (VSD) of the superficial and deep retinal layers, as well as flow voids of the choriocapillaris. Results Twenty-eight eyes of 17 patients and 31 age-matched control eyes of 18 healthy subjects were included. VD and VSD of the deep retinal layer were significantly reduced in hypertensive crisis (P ≤ 0.004). Choriocapillaris signal intensity was more heterogeneous in patients, and flow voids exhibited confluence with a larger average area and a lower absolute count (P ≤ 0.045). These changes were independent of time since onset of hypertensive crisis and of the presence and extent of retinopathy. Deep retinal changes were associated with renal end-organ failure (P = 0.045). Conclusions Hypertensive crisis is associated with a significant reduction in retinal and choroidal capillary perfusion based on OCTA findings. These alterations are independent of retinopathy and related to end-organ damage. Translational Relevance OCTA might help distinguish hypertensive urgency from hypertensive emergency earlier than currently possible.
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Affiliation(s)
| | | | - Carmen Pizarro
- Department of Internal Medicine II-Cardiology/Pneumology, University Hospital Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Ding J, Qu Z, Yu F. A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy: A case report. Medicine (Baltimore) 2020; 99:e20581. [PMID: 32664062 PMCID: PMC7360212 DOI: 10.1097/md.0000000000020581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes. CASE CONCERNS A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia. DIAGNOSIS This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out. INTERVENTIONS The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA. OUTCOMES Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital. CONCLUSION Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.
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Affiliation(s)
- JiaXiang Ding
- Renal Division, Department of Medicine, Peking University International Hospital
| | - Zhen Qu
- Renal Division, Department of Medicine, Peking University International Hospital
| | - Feng Yu
- Renal Division, Department of Medicine, Peking University International Hospital
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key laboratory of Renal Disease, Ministry of Health of China; Key laboratory of CKD prevention and treatment, Ministry of Education of China; Beijing, P.R. China
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Vilela-Martin JF, Yugar-Toledo JC, Rodrigues MDC, Barroso WKS, Carvalho LCBS, González FJT, Amodeo C, Dias VMMP, Pinto FCM, Martins LFR, Malachias MVB, Jardim PCV, Souza DDSMD, Passarelli Júnior O, Barbosa ECD, Polonia JJ, Póvoa RMDS. Luso-Brazilian Position Statement on Hypertensive Emergencies - 2020. Arq Bras Cardiol 2020; 114:736-751. [PMID: 32491016 DOI: 10.36660/abc.20190731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
| | | | - Manuel de Carvalho Rodrigues
- Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal.,Liga de Hipertensão Arterial, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | | | | | | | - Celso Amodeo
- Centro Hospitalar de Vila Nova Gaia, Espinho, Portugal
| | | | | | | | | | - Paulo Cesar Veiga Jardim
- Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brasil.,Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil
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Spontaneous Adrenal Hemorrhage—a Mixed Bag: 18 Cases from a Single Institution. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ma H, Jiang M, Fu Z, Wang Z, Shen P, Shi H, Feng X, Chen Y, Ding X, Wu Z, Zhang W. Clinical value of multiorgan damage in hypertensive crises: A prospective follow-up study. J Clin Hypertens (Greenwich) 2020; 22:914-923. [PMID: 32271999 PMCID: PMC8029737 DOI: 10.1111/jch.13848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/18/2020] [Accepted: 03/04/2020] [Indexed: 12/29/2022]
Abstract
Hypertensive crises are associated with high rates of target organ complications and poor outcomes. A recent shift from the definition of malignant hypertension to hypertension-multiorgan damage (MOD) contributes to the diagnosis and management of hypertensive crises. Here, we prospectively included 166 adult (≥18 years old) patients with hypertensive crises (blood pressure >180/120 mm Hg). Target organs and causes of hypertension were assessed. Patients who were diagnosed with malignant hypertensive retinopathy, the absence of malignant hypertensive retinopathy but the presence of damage to at least 3 organs, and the absence of both retinopathy and MOD were classified as the malignant hypertension (n = 48), hypertension-MOD (n = 42), and hypertension without MOD (n = 76) groups, respectively. Patients were followed to evaluate renal and cardiovascular prognoses. At baseline, patients with malignant hypertension had worse renal function, higher level of albuminuria, and more severe microvascular damage than those with hypertension-MOD. Both had similar proportions of malignant arteriolar nephrosclerosis (83% vs 64%), left ventricular hypertrophy (90% vs 88%), abnormal repolarization (71% vs 60%), and left ventricular dysfunction (12% vs 21%). At the twenty months of follow-up, both the malignant hypertension and hypertension-MOD groups had similar blood pressure control rates and proteinuria. Both groups had worse renal outcomes than the hypertension without MOD group (P = .002). Patients with hypertension-MOD (HR = 0.67, [95% CI: 0.30-1.46], P = .31) had similar renal event-free survival than patients with MHT after adjustments of age, sex, blood pressure, and proteinuria control. These results suggest that in hypertensive crises, both malignant hypertension and hypertension-MOD have impact on adverse renal outcomes.
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Affiliation(s)
- Hongkun Ma
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengdi Jiang
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zongjie Fu
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyu Wang
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pingyan Shen
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Shi
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaobei Feng
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongxi Chen
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyuan Wu
- Department of Interventional Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Zhang
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Seeman T, Hamdani G, Mitsnefes M. Hypertensive crisis in children and adolescents. Pediatr Nephrol 2019; 34:2523-2537. [PMID: 30276533 DOI: 10.1007/s00467-018-4092-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician's initial management of a hypertensive crisis. The main aim of the treatment of hypertensive crisis is the prevention or treatment of life-threatening complications of hypertension-induced organ dysfunction, including neurologic, ophthalmologic, renal, and cardiac complications. While the treatment strategy must be directed toward the immediate reduction of BP to reduce the hypertensive damage to these organs, it should not be at a too fast rate to cause hypoperfusion of vital organs by an excessively rapid reduction of BP. Thus, intravenous continuous infusions rather than intravenous boluses of antihypertensive medications should be the preferable mode of initial treatment of children with hypertensive emergency.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics and Biomedical Center, 2nd Faculty of Medicine and Faculty of Medicine in Pilsen, Charles University in Prague, V Uvalu 84, 15006, Prague 5, Czech Republic. .,Motol University Hospital, V Uvalu 84, 15006, Prague 5, Czech Republic.
| | - Gilad Hamdani
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Malignant hypertension: does this still exist? J Hum Hypertens 2019; 34:1-4. [DOI: 10.1038/s41371-019-0267-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
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Mandi DG, Yaméogo RA, Sebgo C, Bamouni J, Naibé DT, Kologo KJ, Millogo GRC, Yaméogo NV, Thiam-Tall A, Samadoulougou AK, Zabsonré P. Hypertensive crises in sub-Saharan Africa: Clinical profile and short-term outcome in the medical emergencies department of a national referral hospital in Burkina Faso. Ann Cardiol Angeiol (Paris) 2019; 68:269-274. [PMID: 31466723 DOI: 10.1016/j.ancard.2019.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on hypertensive crises (HC) are limited in sub-Saharan Africa (SSA). We aimed to characterize the pattern and short-term mortality of hypertensive emergencies (HE) and urgencies (HU). METHODS This was a prospective cohort study. Consecutive patients with acute and severely elevated blood pressure (systolic>180mmHg and/or diastolic >120mmHg) with or without acute target-organs damage attending the emergency department (ED) of the Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso were included with a one-month follow-up. RESULTS One hundred and sixty-six of 1254 patients presenting to the ED (January to march 2016) had HC (13.2%) and 113 of them (68.1%) had HE. The mean age was 50.9±15.9 years and males were 63.3% (n=105). Younger age (<45 years) accounted for 55% of the cases. History of known HTN was reported in 101 patients (60.8%). Among patients with HE, 62.8% had brain-related events, 30.1% had cardiac involvement and 31% had acute renal impairment. The overall survival rate was 89% within the first 72hours and 81% at fourteen days follow-up. At one-month follow-up, 36 patients died with a survival rate of 77.8%. Factors independently associated with death were history of known hypertension, acute brain-related damage and renal dysfunction and not being transferred to a specialized department. CONCLUSION HC are not rare in SSA and are associated with higher morbidity and mortality in HE. Further studies are needed to determine factors that promote HC in African patients in order to better address the prevention and management strategies of such hypertensive entity.
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Affiliation(s)
- D G Mandi
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso.
| | - R A Yaméogo
- Superior School of Health Sciences, University of Ouahigouya, Ouahigouya, Burkina Faso
| | - C Sebgo
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso
| | - J Bamouni
- Faculty of Human Health Sciences, University of N'Djamena, N'Djamena, Chad
| | - D T Naibé
- UNIHAVRE- UNIROUEN - UNICAEN, CNRS, UMR IDEES, university of Normandie, 25, rue Philippe-Lebon, 76600 Le Havre, France
| | - K J Kologo
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso; Training and Research Unit of Health Sciences, University Ouaga I - Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - G R C Millogo
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso; Training and Research Unit of Health Sciences, University Ouaga I - Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - N V Yaméogo
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso; Training and Research Unit of Health Sciences, University Ouaga I - Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - A Thiam-Tall
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso; Training and Research Unit of Health Sciences, University Ouaga I - Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - A K Samadoulougou
- Training and Research Unit of Health Sciences, University Ouaga I - Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - P Zabsonré
- Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, PO Box 7022, Ouagadougou 03, Burkina Faso; Training and Research Unit of Health Sciences, University Ouaga I - Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
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Li Y, Liu F, Su C, Yu B, Liu D, Chen HJ, Lin DA, Yang C, Zhou L, Wu Q, Xia W, Xie X, Tao J. Biodegradable Therapeutic Microneedle Patch for Rapid Antihypertensive Treatment. ACS APPLIED MATERIALS & INTERFACES 2019; 11:30575-30584. [PMID: 31382742 DOI: 10.1021/acsami.9b09697] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A hypertensive emergency causes severe cardiovascular diseases accompanied by acute target organ damage, requiring rapid and smooth blood pressure (BP) reduction. Current medicines for treating hypertensive emergencies, such as sodium nitroprusside (SNP), require careful dose control to avoid side effects (e.g., cyanide poisoning). The clinical administration of SNP using intravenous injection or drip further restrict its usage for first aid or self-aid in emergencies. Here, we developed an antihypertensive microneedle (aH-MN) technique to transdermally deliver SNP in combination with sodium thiosulfate (ST) as a cyanide antidote in a painless way. Dissolvable microneedles loaded with SNP and ST were fabricated via the centrifugation casting method, where the SNPs were stably packaged in microneedles and would be immediately released into the systemic circulation via subcutaneous capillaries when aH-MNs penetrated the skin. The antihypertensive effects were demonstrated on spontaneously hypertensive rat models. Rapid and potent BP reduction was achieved via aH-MN treatment, fulfilling clinical BP-control requirements for hypertensive emergencies. The side effects including skin irritation and target organ damage of aH-MN therapies were evaluated; the combinative delivery of ST effectively suppressed these side effects induced by the consecutive intake of SNP. This study introduces an efficient and patient-friendly antihypertensive therapy with a favorable side-effect profile, particularly a controllable and self-administrable approach to treat hypertensive emergencies.
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Affiliation(s)
- Yan Li
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
- Department of Cardiovascular Medicine , The First Affiliated Hospital of Jinan University , 510630 Guangzhou , China
| | - Fanmao Liu
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Chen Su
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
| | - Bingbo Yu
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
| | - Di Liu
- Pritzker School of Medicine , University of Chicago , Chicago , Illinois 60637 , United States
| | - Hui-Jiuan Chen
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Di-An Lin
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Chengduan Yang
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Lingfei Zhou
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Qianni Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center , Sun Yat-sen University , 510060 Guangzhou , China
| | - Wenhao Xia
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
| | - Xi Xie
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Electronics and Information Technology , Sun Yat-sen University , 510006 Guangzhou , China
| | - Jun Tao
- Department of Hypertension and Vascular Disease , The First Affiliated Hospital, Sun Yat-sen University , 510080 Guangzhou , China
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Yuan TY, Chen D, Chen YC, Zhang HF, Niu ZR, Jiao XZ, Xie P, Fang LH, Du GH. A novel hypertensive crisis rat model established by excessive norepinephrine infusion and the potential therapeutic effects of Rho-kinase inhibitors on it. Biomed Pharmacother 2018; 109:1867-1875. [PMID: 30551442 DOI: 10.1016/j.biopha.2018.11.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
Abstract
Hypertension crisis is a severe disease and needs emergency treatment in clinic. It is an important task to discover novel drugs which could lower the blood pressure steadily and quickly. However, animal models for screening anti-hypertensive crisis agents are unsatisfactory. The present study aimed to establish a new hypertensive crisis rat model and then explore the therapeutic effects of three Rho-kinase inhibitors including Fasudil, DL0805-1 and DL0805-2 on such a disease model. The hypertensive crisis symptoms were developed on male Wistar rats by subcutaneously injecting small doses of norepinephrine (NE) for 10 days in the initial stage. A sudden increase in blood pressure (BP) was then induced by excessive NE infusion. Compounds to be tested were intravenously injected into the rats immediately when the rapidly increased systolic blood pressure appeared. The results have shown that after small dose administration with NE, the rats could obtain acute BP increase to a high level without sudden death when a large dose of NE was injected. Fasudil, DL0805-1 and DL0805-2 could lower the blood pressure quickly in a dose dependent manner and improve the survival rate. The compounds also prevent the animals from organ damage. In conclusion, we established a novel hypertensive crisis animal model which could evaluate agents within a short time. In this model, we found that three Rho-kinase inhibitors have potential therapeutic effects on hypertensive crisis. This work might contribute to the discovery and development of new anti-hypertensive crisis drugs.
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Affiliation(s)
- Tian-Yi Yuan
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Di Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Yu-Cai Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Hui-Fang Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Zi-Ran Niu
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Xiao-Zhen Jiao
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Ping Xie
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China
| | - Lian-Hua Fang
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China.
| | - Guan-Hua Du
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, 100050, Beijing, China.
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Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2018; 32:1803-1822. [PMID: 30353952 PMCID: PMC6271319 DOI: 10.1111/jvim.15331] [Citation(s) in RCA: 262] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats.
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Affiliation(s)
- Mark J Acierno
- Department of Medicine, College of Veterinary Medicine, Midwestern University, 5715 W. Utopia Rd, Glendale Arizona 85308
| | - Scott Brown
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Amanda E Coleman
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Mark Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Rebecca L Stepien
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin
| | - Harriet M Syme
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
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Shao PJ, Sawe HR, Murray BL, Mfinanga JA, Mwafongo V, Runyon MS. Profile of patients with hypertensive urgency and emergency presenting to an urban emergency department of a tertiary referral hospital in Tanzania. BMC Cardiovasc Disord 2018; 18:158. [PMID: 30068315 PMCID: PMC6090910 DOI: 10.1186/s12872-018-0895-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertensive crises are clinical syndromes grouped as hypertensive urgency and emergency, which occur as complications of untreated or inadequately treated hypertension. Emergency departments across the world are the first points of contact for these patients. There is a paucity of data on patients in hypertensive crises presenting to emergency departments in Tanzania. We aimed to describe the profile and outcome of patients with hypertensive crisis presenting to the Emergency Department of Muhimbili National Hospital in Tanzania. METHODS This was a descriptive cohort study of adult patients aged 18 years and above presenting to the emergency department with hypertensive urgency or emergency over a four-month period. Trained researchers used a structured data sheet to document demographic information, clinical presentation, management and outcome. Descriptive statistics with 95% confidence intervals (CIs) are presented as well as comparisons between the groups with hypertensive urgency vs. emergency. RESULTS We screened 8002 patients and enrolled 203 (2.5%). The median age was 55 (interquartile range 45-67 years) and 51.7% were females. Overall 138 (68%) had hypertensive emergency; and 65 (32%) had hypertensive urgency, for an overall rate of 1.7% (95% CI: 1.5 to 2.0%) and 0.81% (95% CI: 0.63 to 1.0%), respectively. Altered mental status was the most common presenting symptom in hypertensive emergency [74 (53.6%)]; low Glasgow Coma Scale was the most common physical finding [61 (44.2%)]; and cerebrovascular accident was the most common final diagnosis [63 (31%)]. One hundred twelve patients with hypertensive emergency (81.2%) were admitted and three died in the emergency department, while 24 patients with hypertensive urgency (36.9%) were admitted and none died in the emergency department. In-hospital mortality rates for hypertensive emergency and urgency were 37 (26.8%) and 2 (3.1%), respectively. CONCLUSION In our cohort of adult patients with elevated blood pressure, hypertensive crisis was associated with substantial morbidity and mortality, with the most vulnerable being those with hypertensive emergency. Further research is required to determine the aetiology, pathophysiology and the most appropriate strategies for prevention and management of hypertensive crisis.
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Affiliation(s)
- Patrick J. Shao
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Hendry R. Sawe
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Brittany L. Murray
- Division of Paediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Juma A. Mfinanga
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Victor Mwafongo
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Michael S. Runyon
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina USA
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Acute blood pressure elevation: Therapeutic approach. Pharmacol Res 2018; 130:180-190. [DOI: 10.1016/j.phrs.2018.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/21/2017] [Accepted: 02/21/2018] [Indexed: 12/25/2022]
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Kumar CM, Seet E, Eke T, Joshi GP. Hypertension and cataract surgery under loco-regional anaesthesia: not to be ignored? Br J Anaesth 2017; 119:855-859. [PMID: 29028916 DOI: 10.1093/bja/aex247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- C M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore
| | - E Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore
| | - T Eke
- Department of Ophthalmology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - G P Joshi
- Department of Anaesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Lee A, Shin CW, Son WG, Kim J, Jo SM, Kim WH, Lee I. Anesthesia Case of the Month. J Am Vet Med Assoc 2017; 250:1379-1385. [PMID: 28569638 DOI: 10.2460/javma.250.12.1379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shantsila A, Lip GYH. Malignant Hypertension Revisited-Does This Still Exist? Am J Hypertens 2017; 30:543-549. [PMID: 28200072 DOI: 10.1093/ajh/hpx008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 01/06/2017] [Indexed: 12/27/2022] Open
Abstract
Malignant or accelerated hypertension is the most severe form of hypertension, defined clinically by very high blood pressure (diastolic above 130 mm Hg) accompanied by bilateral retinal hemorrhages and/or exudates, with or without papilledema. The aim of this review is to discuss if malignant hypertension still poses a clinically relevant entity and to highlight the diagnostic challenges of this form of hypertension. The substantial improvement in prognosis in patients with malignant hypertension over the last decades is well documented, but there is no strong evidence to suggest a significant change in its incidence. In fact, with the growing population and improving life expectancy, malignant hypertension is likely to become even more prevalent worldwide, especially in the developing countries with less advanced health care services. Despite simple diagnostic criteria of malignant hypertension, the diagnoses may be difficult in many patients. Malignant hypertension patients often have the diagnosis established only when the target organ damage occur. Furthermore, retrospective diagnosis is problematic, as malignant hypertensive retinopathy gradually resolves over a relatively short period of time, while persistent target organ damage will, however, lead to the development of complications and much poorer prognosis than in nonmalignant hypertension patients. Certainly, malignant hypertension still poses a clinically relevant and challenging form of hypertension and its possibility should be always considered during the assessment of patients with poorly controlled hypertension.
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Affiliation(s)
- Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Chang J, Yao W, Li X. A Context-Aware S-Health Service System for Drivers. SENSORS 2017; 17:s17030609. [PMID: 28304330 PMCID: PMC5375895 DOI: 10.3390/s17030609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/03/2022]
Abstract
As a stressful and sensitive task, driving can be disturbed by various factors from the health condition of the driver to the environmental variables of the vehicle. Continuous monitoring of driving hazards and providing the most appropriate business services to meet actual needs can guarantee safe driving and make great use of the existing information resources and business services. However, there is no in-depth research on the perception of a driver’s health status or the provision of customized business services in case of various hazardous situations. In order to constantly monitor the health status of the drivers and react to abnormal situations, this paper proposes a context-aware service system providing a configurable architecture for the design and implementation of the smart health service system for safe driving, which can perceive a driver’s health status and provide helpful services to the driver. With the context-aware technology to construct a smart health services system for safe driving, this is the first time that such a service system has been implemented in practice. Additionally, an assessment model is proposed to mitigate the impact of the acceptable abnormal status and, thus, reduce the unnecessary invocation of the services. With regard to different assessed situations, the business services can be invoked for the driver to adapt to hazardous situations according to the services configuration model, which can take full advantage of the existing information resources and business services. The evaluation results indicate that the alteration of the observed status in a valid time range T can be tolerated and the frequency of the service invocation can be reduced.
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Affiliation(s)
- Jingkun Chang
- Beijing Key Laboratory of Intelligent Telecommunications Software and Multimedia, Beijing University of Posts and Telecommunications, Beijing 100876, China.
| | - Wenbin Yao
- Beijing Key Laboratory of Intelligent Telecommunications Software and Multimedia, Beijing University of Posts and Telecommunications, Beijing 100876, China.
| | - Xiaoyong Li
- The Key Laboratory of Trustworthy Distributed Computing and Service, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing 100876, China.
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