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Lee JH, Kim HW, Kim SA, Ju WT, Kim SR, Kim HB, Cha IS, Kim SW, Park JW, Kang SK. Modulatory Effects of the Kuwanon-Rich Fraction from Mulberry Root Bark on the Renin-Angiotensin System. Foods 2024; 13:1547. [PMID: 38790847 PMCID: PMC11121332 DOI: 10.3390/foods13101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/01/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
In this study, we investigated the anti-hypertensive properties of mulberry products by modulating the renin-angiotensin system (RAS). Comparative analysis showed that the ethyl acetate fractions, particularly from the Cheongil and Daeshim cultivars, contained the highest levels of polyphenols and flavonoids, with concentrations reaching 110 mg gallic acid equivalent (GE)/g and 471 mg catechin equivalent (CE)/g of extract, respectively. The ethyl acetate fraction showed superior angiotensin-converting enzyme (ACE) inhibitory activity, mainly because of the presence of the prenylated flavonoids kuwanon G and H. UPLC/Q-TOF-MS analysis identified kuwanon G and H as the primary active components, which significantly contributed to the pharmacological efficacy of the extract. In vivo testing of mice fed a high-salt diet showed that the ethyl acetate fraction substantially reduced the heart weight and lowered the serum renin and angiotensinogen levels by 34% and 25%, respectively, highlighting its potential to modulate the RAS. These results suggested that the ethyl acetate fraction of mulberry root bark is a promising candidate for the development of natural ACE inhibitors. This finding has significant implications for the management of hypertension through RAS regulation and the promotion of cardiovascular health in the functional food industry.
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Affiliation(s)
- Ji-Hae Lee
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Heon-Woong Kim
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - So-Ah Kim
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Wan-Taek Ju
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Seong-Ryul Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Hyun-Bok Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Ik-Seob Cha
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Seong-Wan Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Jong-Woo Park
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Sang-Kuk Kang
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
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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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Koracevic G, Stojanovic M, Zdravkovic M, Lovic D, Simic D, Mladenovic K. Proposal of a Modified Classification of Hypertensive Crises: Urgency, Impending Emergency, and Emergency. Curr Vasc Pharmacol 2024; 22:180-186. [PMID: 39188222 DOI: 10.2174/0115701611270174231204110557] [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: 07/30/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 08/28/2024]
Abstract
Systemic arterial hypertension (HTN) is the main cause of morbidity and mortality, and HTN crises contribute significantly to an unfavourable clinical course. For decades, HTN crises have been dichotomized into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). The main difference between the two is the presence of acute hypertension-mediated organ damage (HMOD) - if HMOD is present, HTN crisis is HTN-E; if not, it is HTN-U. Patients with HTN-E are in a life-threatening situation. They are hospitalized and receive antihypertensive drugs intravenously (IV). On the other hand, patients with HTN-U are usually not hospitalized and receive their antihypertensives orally. We suggest a modification of the current risk stratification scheme for patients with HTN crises. The new category would be the intermediate risk group, more precisely the 'impending HTN-E' group, with a higher risk in comparison to HTN-U and a lower risk than HTN-E. 'Impending HMOD' means that HMOD has not occurred (yet), and the prognosis is, therefore, better than in patients with ongoing HMOD. There are three main reasons to classify patients as having impending HTN-E: excessively elevated BP, high-risk comorbidities, and ongoing bleeding/high bleeding risk. Their combinations are probable. This approach may enable us to prevent some HTNEs by avoiding acute HMOD using a timely blood pressure treatment. This treatment should be prompt but controlled.
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Affiliation(s)
- Goran Koracevic
- Clinic for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, Nis University, Nis, Serbia
| | - Milovan Stojanovic
- Faculty of Medicine, Nis University, Nis, Serbia
- Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia
| | - Marija Zdravkovic
- Department of Cardiovascular Diseases, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Dragan Lovic
- Singidunum University, School of Medicine, Belgrade, Serbia
- Department of Cardiovascular Diseases, Clinic for Internal Diseases Inter Medica, Nis, Serbia
| | - Dragan Simic
- Department of Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Katarina Mladenovic
- Department of Biology and Ecology, Faculty of Science, University of Kragujevac, Serbia
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4
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Thi Hai Van H, Thi Huong D, Ngoc Anh T. Validity of self-reported hypertension and associated factors among Vietnamese adults: a cross-sectional study. Blood Press 2023; 32:2288313. [PMID: 38037302 DOI: 10.1080/08037051.2023.2288313] [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: 09/15/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND This study aims to determine the validity of self-reported hypertension and identify factors affecting the disagreement between self-reported hypertension and objective measures of blood pressure among adults in Vietnam. MATERIALS AND METHODS A total of 4,219 people aged 18 and older reported their hypertension status and had their blood pressure measured. The inter-reliability between self-reported and measured hypertension was assessed using Cohen's Kappa statistics. Univariate and multivariate logistic regressions were used to examine the affecting factors of disagreement. RESULT Self-reported hypertension prevalence was 13.2% (557/4,219), while measured hypertension was 20.9% (881/4,219). An agreement between self-reported and measured data was moderate for the hypertension of participants (κ = 0.39, 95% CI 0.36-0.43). Self-reported hypertension showed high specificity (93.9%) (95% CI 93.0-94.7) but low sensitivity (40.1%; 95 CI 36.8-43.4). The percentage of disagreement in hypertension (number of false positives and false negatives between self-reported and measured data) among adults in Vietnam was 17.3%. CONCLUSION Our findings showed there was a high disagreement percentage of hypertension between self-reported and measured data. This is the first report of this issue to warn of health risks if high blood pressure is not detected early. The disagreement of hypertension was observed more frequently in men, people older than 40, minority ethnic groups, farmers, and people with a BMI greater than 25 kg/m2.
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Affiliation(s)
- Hoang Thi Hai Van
- Department of Global Health, School of Preventive and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Dang Thi Huong
- Center for Training and Research on HIV and substance Abuse, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Ngoc Anh
- Preventive Medicine Doctor Student, School of Preventive and Public Health, Hanoi Medical University, Hanoi, Vietnam
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Gezie H, Azazh A, Melaku B, Gelaye H. Determinants of hypertensive crisis among hypertensive patients at adult emergency departments of public hospitals in Addis Ababa, Ethiopia, 2021: a case-control study. Int J Emerg Med 2023; 16:68. [PMID: 37814211 PMCID: PMC10563236 DOI: 10.1186/s12245-023-00549-2] [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: 03/04/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a major global health problem that affects approximately 1.13 billion people worldwide, and 1-2% of this population has hypertensive crisis. Hypertensive crisis is becoming a major health issue in low-income countries. However, few studies have been conducted in developing countries such as Ethiopia. This study aimed to assess the determinants of hypertensive crisis among patients visiting adult emergency departments of public hospitals in Addis Ababa. METHOD A hospital-based unmatched case-control study was conducted among 85 cases with a hypertensive crisis and 170 controls with hypertension without a hypertensive crisis in the adult emergency departments of public hospitals in Addis Ababa from March 15 to May 15, 2021. Data were collected using a structured questionnaire and analyzed using SPSS version 26. Binary logistic regression and multivariable logistic regression were performed. Finally, a statistically significant level was declared at a p value of less than 0.05. The result was summarized and presented in text, tables, and graph. RESULT The odds of having hypertensive crisis were 3.6 times (AOR = 3.621) higher among participants with a history of hypertension compared to those without a history of hypertension. There was also 4 times increased risk of hypertensive crisis among participants who presented with diabetes mellitus than participants who presented without it (AOR = 4.179). Similarly, participants who presented with stroke had 7 times higher odds of having hypertensive crisis (AOR = 7.174) than participants without stroke. CONCLUSION This study demonstrated a statistically significant association between unemployment, diabetes mellitus, stroke, heart failure, history of hypertension, family history of hypertension, and regular follow-up with a hypertensive crisis. The Ethiopian Ministry of Health, Ababa City Administration Health Bureau, and hospitals shall give due attention to the HTN crisis. Health care workers, hospital managers, and other stakeholders shall work towards the early detection and management of HTN-crisis to prevent related morbidity, disability, and mortality.
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Affiliation(s)
- Hailemariam Gezie
- Department of Emergency and Critical Care Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Aklilu Azazh
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Melaku
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Habtam Gelaye
- Department of Psychiatry, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Pothuru S, Chan WC, Mehta H, Vindhyal MR, Ranka S, Hu J, Yarlagadda SG, Wiley MA, Hockstad E, Tadros PN, Gupta K. Burden of Hypertensive Crisis in Patients With End-Stage Kidney Disease on Maintenance Dialysis: Insights From United States Renal Data System Database. Hypertension 2023; 80:e59-e67. [PMID: 36752114 DOI: 10.1161/hypertensionaha.122.20546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is paucity of information on the incidence, clinical characteristics, admission trends, and outcomes of hypertensive crisis (HTN-C) in patients with end-stage kidney disease (ESKD) who are on maintenance dialysis. METHODS We conducted a retrospective observational study of HTN-C admissions in patients with end-stage kidney disease using the United States Renal Data System. We identified patients with end-stage kidney disease aged ≥18 years on dialysis and were hospitalized for HTN-C from January 2006 to August 2015. RESULTS A total of 54 483 patients with end-stage kidney disease were hospitalized for HTN-C during the study period. After study exclusions, 37 214 patients were included in the analysis. A majority of patients were Black, there were more women than men and the South region of the country accounted for a great majority of patients. During the study period, hospitalization rates increased from 1060 per 100 000 beneficiary years to 1821 (Ptrend<0.0001). Overall, in-hospital mortality, 30-day, and 1-year mortality were 0.6%, 2.3%, and 21.8%, respectively, and 30-day readmission rate was 31.1%. During the study period, most study outcomes showed a significant decreasing trend (in-hospital mortality 0.6%-0.5%, 30-day mortality 2.4%-1.9%, 1-year mortality 23.9%-19.7%, Ptrend<0.0001 for all). CONCLUSIONS Hospitalizations for HTN-C have increased consistently during the decade studied. Although temporal trends showed improving mortality and readmission rates, the absolute rates were still high with 1 in 3 patients readmitted within 30 days and 1 in 5 patients dying within 1 year of index hospitalization.
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Affiliation(s)
- Suveenkrishna Pothuru
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City.,Department of Internal Medicine, Ascension Via Christi Hospital, Manhattan, KS (S.P.)
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Harsh Mehta
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Mohinder R Vindhyal
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Sagar Ranka
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas School of Medicine (J.H.)
| | - Sri G Yarlagadda
- Division of Nephrology and Hypertension, Department of Internal Medicine (S.G.Y.), University of Kansas School of Medicine, Kansas City
| | - Mark A Wiley
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Eric Hockstad
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Peter N Tadros
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Kamal Gupta
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
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Meher M, Pradhan S, Pradhan SR. Risk Factors Associated With Hypertension in Young Adults: A Systematic Review. Cureus 2023; 15:e37467. [PMID: 37187665 PMCID: PMC10181897 DOI: 10.7759/cureus.37467] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
On a global scale, hypertension ranks third among the six major risk factors for cardiovascular disease. The risk of heart disease, stroke, and renal failure is all significantly increased by hypertension. We looked for papers on risk factors associated with hypertension in young adults on Google Scholar and PubMed. "Hypertension," "young adults," and "risk factors" were the search terms. Eligibility testing was done in a standardized, non-blinded way. The first author, year of publication, subject related to hypertension in young adults, and risk factors associated with hypertension in young adults were all retrieved from each paper. A PubMed search yielded 150 results. In all, 10 papers were considered in our review, which were published between 2017 and 2021. Most of the studies considered were carried out by foreign research groups. Adults who smoke, chew tobacco, drink alcohol, are obese, engage in sedentary behavior, consume too much salt, and have unhealthy lifestyles are at a higher risk of developing hypertension. In addition to these risk factors, there were additional important risk variables such as illiteracy, illness ignorance, a disregard for one's health, and a society that values men more than women. The way of life is radically altering because of people adjusting to Western culture. Smoking, drinking, being overweight, and eating too much salt are the primary risk factors for hypertension. This shows that in order to live a happier and healthier life, it is important to increase people's understanding of and attitudes toward the prevention and control of hypertension.
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Affiliation(s)
- Meghanad Meher
- General Medicine, Institute of Medical Sciences (IMS) and Sum Hospital, Siksha 'O' Anusandhan (SOA) Deemed to be University, Bhubaneswar, IND
| | - Sourabh Pradhan
- General Medicine, Institute of Medical Sciences (IMS) and Sum Hospital, Siksha 'O' Anusandhan (SOA) Deemed to be University, Bhubaneswar, IND
| | - Soumya Ranjan Pradhan
- General Medicine, Institute of Medical Sciences (IMS) and Sum Hospital, Siksha 'O' Anusandhan (SOA) Deemed to be University, Bhubaneswar, IND
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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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9
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Mishra P, Dash N, Sahu SK, Kanaujia V, Sharma K. Malignant Hypertension and the Role of Ophthalmologists: A Review Article. Cureus 2022; 14:e27140. [PMID: 36017304 PMCID: PMC9392986 DOI: 10.7759/cureus.27140] [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] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient’s life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice.
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Salman BI, Hassan YF, Eltoukhi WE, Saraya RE. Quantification of tyramine in different types of food using novel green synthesis of ficus carica quantum dots as fluorescent probe. LUMINESCENCE 2022; 37:1259-1266. [PMID: 35586926 DOI: 10.1002/bio.4291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
Tyramine (TYM) is catecholamine releasing compound, tyramine rich food causing hypertensive crisis due to combination with monoamine oxidase inhibitor (MAOIs). So, Analysis of TYM in tyramine rich food (old cheese, cured meat, sausage, pickled olive and canned fish) and environment is very essential for hypertensive patients and improvement food industries. In this work, TYM was analyzed in different types of food using novel green synthesis carbon dots from ficus carica (Fig fruits). The gradual addition of TYM to PA@CQDs led to enhancement of the quantum dots fluorescence due to formation of hydrogen bonding between quantum dots and TYM. The calibration graph plotted in the range 5-400 ng mL-1 . The method was applied to determination of TYM in different types of food as old cheese, cured meat, sausage, pickled olive and canned fish. The lower limit of quantitation (LOQ) was found to be 1.68 ng mL-1 . The method successfully applied for the quantification of TYM in varying types of food with high sensitivity and high economic effect due to the reusability of the quantum dots. The optical and morphological characters of quantum dots were studied carefully.
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Affiliation(s)
- Baher I Salman
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University - Assiut branch, Assiut, Egypt
| | - Yasser F Hassan
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University - Assiut branch, Assiut, Egypt
| | - Walid E Eltoukhi
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University - Assiut branch, Assiut, Egypt
| | - Roshdy E Saraya
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Port Said University, Port Said, Egypt
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11
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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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12
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Agregán R, Pateiro M, Bohrer BM, Shariati MA, Nawaz A, Gohari G, Lorenzo JM. Biological activity and development of functional foods fortified with okra ( Abelmoschus esculentus). Crit Rev Food Sci Nutr 2022; 63:6018-6033. [PMID: 35037792 DOI: 10.1080/10408398.2022.2026874] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Abelmoschus esculentus plant, better known as okra, is an interesting crop from a nutritional standpoint. The okra plant is native to the African region but can now be found throughout tropical and subtropical areas of the world. This plant, known for its healing abilities, has been used as a traditional medicine to treat several diseases and external ailments, such as wounds or boils. This article reviews the potential health benefits from okra consumption, as well as the bioactive compounds that are suggested to be responsible. Furthermore, the okra plant and its derivatives have been evaluated in the formulation and manufacture of new functional food products. The latest advances in this direction, which includes characterizing the technical properties of functional foods fortified with okra are also presented in this review. A series of bioactive compounds such as flavonoids and catechins have been found in the okra plant, which were associated with numerous biological properties observed in research studies that reported potential anti-diabetic, anti-cancer, anti-hypertensive, and antimicrobial effects, among others, as a result of their consumption. These potential health benefits contribute to the development of new and useful functional foods, with okra (or its derivatives) being used as the highlighted ingredient.
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Affiliation(s)
- Rubén Agregán
- Centro Tecnológico de la Carne de Galicia, Parque Tecnológico de Galicia, Ourense, Spain
| | - Mirian Pateiro
- Centro Tecnológico de la Carne de Galicia, Parque Tecnológico de Galicia, Ourense, Spain
| | - Benjamin M Bohrer
- Department of Animal Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Mohammad Ali Shariati
- Department of Scientific Research, K.G. Razumovsky Moscow State University of Technologies and Management (The First Cossack University), 109004 Moscow, Russia Federation
| | - Asad Nawaz
- Jiangsu Key Laboratory of Crop Genetics and Physiology, College of Agriculture, Yangzhou University, Yangzhou, China
| | - Gholamreza Gohari
- Faculty of Agriculture, Department of Horticulture, University of Maragheh, Maragheh, Iran
| | - José M Lorenzo
- Centro Tecnológico de la Carne de Galicia, Parque Tecnológico de Galicia, Ourense, Spain
- Área de Tecnología de los Alimentos, Facultad de Ciencias de Ourense, Universidad de Vigo, Ourense, Spain
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13
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van Etten ES, Kaushik K, Jolink WMT, Koemans EA, Ekker MS, Rasing I, Voigt S, Schreuder FHBM, Cannegieter SC, Rinkel GJE, Lijfering WM, Klijn CJM, Wermer MJH. Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study. Stroke 2021; 53:1692-1699. [PMID: 34911344 DOI: 10.1161/strokeaha.121.036233] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset. METHODS We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors. RESULTS We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8-3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3-6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2-19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7-60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8-55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4-63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6-37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1-95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7-6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9-4.2). CONCLUSIONS We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.
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Affiliation(s)
- Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Kanishk Kaushik
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Wilmar M T Jolink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands. (S.C.C.)
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Willem M Lijfering
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.)
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.).,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
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14
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Lu Y, Wang Y, Spatz ES, Onuma O, Nasir K, Rodriguez F, Watson KE, Krumholz HM. National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999-2019). Circulation 2021; 144:1683-1693. [PMID: 34743531 DOI: 10.1161/circulationaha.121.057056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the past 2 decades, hypertension control in the US population has not improved and there are widening disparities. Little is known about progress in reducing hospitalizations for acute hypertension. METHODS We conducted serial cross-sectional analysis of Medicare fee-for-service beneficiaries age 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files. We evaluated trends in national hospitalization rates for acute hypertension overall and by demographic and geographical subgroups. We identified all beneficiaries admitted with a primary discharge diagnosis of acute hypertension on the basis of International Classification of Diseases codes. We then used a mixed effects model with a Poisson link function and state-specific random intercepts, adjusting for age, sex, race and ethnicity, and dual-eligible status, to evaluate trends in hospitalizations. RESULTS The sample consisted of 397 238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for acute hypertension increased significantly, from 51.5 to 125.9 per 100 000 beneficiary-years; the absolute increase was most pronounced among the following subgroups: adults ≥85 years (66.8-274.1), females (64.9-160.1), Black people (144.4-369.5), and Medicare/Medicaid insured (dual-eligible, 93.1-270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Black and White people from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South. Among patients hospitalized for acute hypertension, the observed 30-day and 90-day all-cause mortality rates (95% CI) decreased from 2.6% (2.27-2.83) and 5.6% (5.18-5.99) to 1.7% (1.53-1.80) and 3.7% (3.45-3.84) and 30-day and 90-day all-cause readmission rates decreased from 15.7% (15.1-16.4) and 29.4% (28.6-30.2) to 11.8% (11.5-12.1) and 24.0% (23.5-24.6). CONCLUSIONS Among Medicare fee-for-service beneficiaries age 65 years or older, hospitalization rates for acute hypertension increased substantially and significantly from 1999 to 2019. Black adults had the highest hospitalization rate in 2019 across age, sex, race and ethnicity, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.)
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Y.W.)
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.)
| | - Oyere Onuma
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (K.N.).,Center for Outcomes Research, Houston Methodist Research Institute, TX (K.N.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, CA (F.R.)
| | - Karol E Watson
- David Geffen School of Medicine, University of California, Los Angeles (K.E.W.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.).,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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15
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Cao Y, Xie L, Liu K, Liang Y, Dai X, Wang X, Lu J, Zhang X, Li X. The antihypertensive potential of flavonoids from Chinese Herbal Medicine: A review. Pharmacol Res 2021; 174:105919. [PMID: 34601080 DOI: 10.1016/j.phrs.2021.105919] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
With the coming of the era of the aging population, hypertension has become a global health burden to be dealt with. Although there are multiple drugs and procedures to control the symptoms of hypertension, the management of it is still a long-term process, and the side effects of conventional drugs pose a burden on patients. Flavonoids, common compounds found in fruits and vegetables as secondary metabolites, are active components in Chinese Herbal Medicine. The flavonoids are proved to have cardiovascular benefits based on a plethora of animal experiments over the last decade. Thus, the flavonoids or flavonoid-rich plant extracts endowed with anti-hypertension activities and probable mechanisms were reviewed. It has been found that flavonoids may affect blood pressure in various ways. Moreover, despite the substantial evidence of the potential for flavonoids in the control of hypertension, it is not sufficient to support the clinical application of flavonoids as an adjuvant or core drug. So the synergistic effects of flavonoids with other drugs, pharmacokinetic studies, clinical trials and the safety of flavonoids are also incorporated in the discussion. It is believed that more breakthrough studies are needed. Overall, this review may shed some new light on the explicit recognition of the mechanisms of anti-hypertension actions of flavonoids, pointing out the limitations of relevant research at the current stage and the aspects that should be strengthened in future researches.
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Affiliation(s)
- Yi Cao
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Long Xie
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Kai Liu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Youdan Liang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xiaolin Dai
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xian Wang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Jing Lu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xumin Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xiaofang Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
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16
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Nkoke C, Noubiap JJ, Dzudie A, Jingi A, Njume D, Teuwafeu D, Aseneh J, Nkouonlack C, Menanga A, Kingue S. Epidemiology of hypertensive crisis in the Buea Regional Hospital, Cameroon. J Clin Hypertens (Greenwich) 2020; 22:2105-2110. [DOI: 10.1111/jch.14035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Clovis Nkoke
- Buea Regional Hospital Buea Cameroon
- Clinical Research Education Networking and Consultancy Douala Cameroon
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy Douala Cameroon
- Douala General Hospital Douala Cameroon
- Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon
| | - Ahmadou Jingi
- Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon
| | - Debimeh Njume
- Faculty of Health Sciences University of Buea Buea Cameroon
| | - Denis Teuwafeu
- Faculty of Health Sciences University of Buea Buea Cameroon
| | - Jerry Aseneh
- Faculty of Health Sciences University of Buea Buea Cameroon
| | | | - Alain Menanga
- Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon
| | - Samuel Kingue
- Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon
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17
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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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18
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Lee SJ, Lee DH, Kim HW. Novel Antihypertension Mechanism of β-Glucan by Corin and ANP-Mediated Natriuresis in Mice. MYCOBIOLOGY 2020; 48:399-409. [PMID: 33177919 PMCID: PMC7580771 DOI: 10.1080/12298093.2020.1812150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Many of the β-glucans are known to have antihypertensive activities, but, except for angiotensin-converting enzyme II inhibition, the underlying mechanisms remain unclear. Corin is an atrial natriuretic peptide (ANP)-converting enzyme. Activated corin cleaves pro-ANP to ANP, which regulates water-sodium balance and lowers blood pressure. Here, we reported a novel antihypertensive mechanism of β-glucans, involved with corin and ANP in mice. We showed that multiple oral administrations of β-glucan induced the expression of corin and ANP, and also increased natriuresis in mice. Microarray analysis showed that corin gene expression was only upregulated in mice liver by multiple, not single, oral administrations of the β-glucan fraction of Phellinus baumii (BGF). Corin was induced in liver and kidney tissues by the β-glucans from zymosan and barley, as well as by BGF. In addition to P. baumii, β-glucans from two other mushrooms, Phellinus linteus and Ganoderma lucidum, also induced corin mRNA expression in mouse liver. ELISA immunoassays showed that ANP production was increased in liver tissue by all the β-glucans tested, but not in the heart and kidney. Urinary sodium excretion was significantly increased by treatment with β-glucans in the order of BGF, zymosan, and barley, both in 1% normal and 10% high-sodium diets. In conclusion, we found that the oral administration of β-glucans could induce corin expression, ANP production, and sodium excretion in mice. Our findings will be helpful for investigations of β-glucans in corin and ANP-related fields, including blood pressure, salt-water balance, and circulation.
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Affiliation(s)
- Sun Jung Lee
- Department of Life Science, University of Seoul, Seoul, Republic of Korea
| | - Dong Hee Lee
- Department of Life Science, University of Seoul, Seoul, Republic of Korea
| | - Ha Won Kim
- Department of Life Science, University of Seoul, Seoul, Republic of Korea
- CONTACT Ha Won Kim
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19
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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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20
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The association between blood pressure decreasing rates and survival time in patients with acute intracerebral hemorrhage. J Neurol Sci 2019; 406:116449. [DOI: 10.1016/j.jns.2019.116449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 11/18/2022]
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21
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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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Liu H, Su WW, Long CF, Zhang WJ, Li PB, Wu Z, Liao YY, Zeng X, Chen TB, Zheng YY, Yan ZH, Bi C, Yao HL. An experimental model for hypertensive crises emergencies: Long-term high-fat diet followed by acute vasoconstriction stress on spontaneously hypertensive rats. Exp Biol Med (Maywood) 2018; 243:481-495. [PMID: 29444597 PMCID: PMC5882032 DOI: 10.1177/1535370218759270] [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: 09/18/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022] Open
Abstract
Currently, the prevention and treatment of hypertensive crises especially when it occurs with serious adverse outcomes have led to worldwide controversy. Despite of clinical possibilities of multiple agents, clinical failures still occur frequently. Therefore, early evaluations and observations of different therapies on appropriate animals should be emphasized. In the present study, an animal model for hypertensive crises emergencies was firstly established and experimentally testified. Five-month-male spontaneously hypertensive rat was consecutively fed with 60%-Kcal fat diet for four, six, and eight weeks with body weight and blood pressure monitored every two weeks, and then followed by an acute vasoconstriction stress of 5-min ice-bath treatment in the 4-h time interval of two adrenaline injections (0.8 mg/kg). Forty-four biochemical parameters were detected, covering hepatic and renal function, blood glucose and lipid levels, myocardial enzymes and energy metabolisms, blood coagulative and anti-coagulative system, oxidative stress and anti-inflammatory cytokine, blood viscosity, and RAAS system. Six tissues including heart, brain, liver, kidney, coronary arteries, and mesenteries were removed for pathological observations with hematoxylin-eosin staining. As a result, multi-organ dysfunctions in the heart, brain, liver, kidney, vascular endothelium, and blood system were testified in the modeling rats at weeks 6 and 8. In conclusion, severe consequences of this animal model were highly similar to those in hypertensive crises emergencies, which could be further utilized in the early intervention of hypertensive crises emergencies including the possible risk factors control and efficient therapies assessment. Impact statement In the late 90s, numerous reports predicted that 1-2% of hypertensive individuals would undergo hypertensive crises (HPC) and figures reached as high as 7% when no antihypertensive therapies were administrated. Currently, clinical failures appear frequently due to the improper or excessive medication regimen instead of the illness itself. Therefore, early evaluations and observations of HPC on appropriate animal models ahead of patients should be discussed and emphasized more widely. In the present study, an appropriate animal model for HPC emergencies was firstly established, in which the consequences of long-term high-fat diet feeding followed by an acute vasoconstriction stress on the spontaneously hypertensive rats were experimentally testified. The proposed model would have a wide application prospects in early intervention of HPC emergencies including the controls of possible risk factors and assessments of efficient therapies.
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Affiliation(s)
- Hong Liu
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Wei-Wei Su
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Chao-Feng Long
- Guangdong Zhongsheng Pharmaceutical Co., Ltd, Dongguan 523325, P.R. China
| | - Wei-Jian Zhang
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Pei-Bo Li
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Zhong Wu
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Yin-Yin Liao
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Xuan Zeng
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Tao-Bin Chen
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Yu-Ying Zheng
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Zeng-Hao Yan
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Cong Bi
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Hong-Liang Yao
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Re-evaluation of Post-marketed TCM, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, P.R. China
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Guiga H, Decroux C, Michelet P, Loundou A, Cornand D, Silhol F, Vaisse B, Sarlon-Bartoli G. Hospital and out-of-hospital mortality in 670 hypertensive emergencies and urgencies. J Clin Hypertens (Greenwich) 2017; 19:1137-1142. [PMID: 28866866 DOI: 10.1111/jch.13083] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 01/24/2023]
Abstract
Long-term mortality in patients with acute severe hypertension is unclear. The authors aimed to compare short-term (hospital) and long-term (12 months) mortality in these patients. A total of 670 adults presenting for acute severe hypertension between January 1, 2015, and December 31, 2015, were included. A total of 57.5% were hypertensive emergencies and 66.1% were hospitalized: 98% and 23.2% of those with hypertensive emergencies and urgencies, respectively (P = .001). Hospital mortality was 7.9% and was significantly higher for hypertensive emergencies (12.5% vs 1.8%, P = .001). At 12 months, 106 patients died (29.4%), mainly from hypertensive emergencies (38.9% vs 8.9%, P = .001). Median survival was 14 days for neurovascular emergencies and 50 days for cardiovascular emergencies. Patients with hypertensive emergencies or urgencies had bad long-term prognosis. Short-term mortality is mainly caused by neurovascular emergencies, but cardiovascular emergencies are severe, with high mortality at 12 months. These results justify better follow-up and treatment for these patients.
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Affiliation(s)
- Haythem Guiga
- Unité d'Hypertension Artérielle, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - Clémentine Decroux
- Service d'Accueil des Urgences de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Pierre Michelet
- Service d'Accueil des Urgences de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,UMR MD2, Aix Marseille Université, Marseille, France
| | - Anderson Loundou
- Direction de la recherche clinique et innovation, unité méthodologique, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Dimitri Cornand
- Unité d'Hypertension Artérielle, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - François Silhol
- Unité d'Hypertension Artérielle, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - Bernard Vaisse
- Unité d'Hypertension Artérielle, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - Gabrielle Sarlon-Bartoli
- Unité d'Hypertension Artérielle, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.,Unité INSERM NORT 1062, Faculté de médecine de Marseille, Aix-Marseille Université, Marseille, France
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Varounis C, Katsi V, Nihoyannopoulos P, Lekakis J, Tousoulis D. Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature. Front Cardiovasc Med 2017; 3:51. [PMID: 28119918 PMCID: PMC5222786 DOI: 10.3389/fcvm.2016.00051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/23/2016] [Indexed: 12/03/2022] Open
Abstract
Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-specific symptoms, whereas heart-related symptoms (dyspnea, chest pain, arrhythmias, and syncope) are less common. Hypertensive crises can be divided into hypertensive emergencies or hypertensive urgencies according to the presence or absence of acute target organ damage, respectively. This differentiation is an extremely useful classification in clinical practice since a different management is needed, which in turn has a significant effect on the morbidity and mortality of these patients. Therefore, it is very crucial for the physician in the emergency department to identify the hypertensive emergencies and to manage them through blood pressure lowering medications in order to avoid further target organ damage or deterioration. The aim of this narrative review is to summarize the recent evidence in an effort to improve the awareness, recognition, risk stratification, and treatment of hypertensive crisis in patients referred to the emergency department.
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Affiliation(s)
- Christos Varounis
- 2nd Department of Cardiology, Attikon University Hospital , Athens , Greece
| | - Vasiliki Katsi
- Cardiology Department, Hippokration General Hospital , Athens , Greece
| | - Petros Nihoyannopoulos
- 1st Department of Cardiology, Athens University Medical School, Hippokration Hospital , Athens , Greece
| | - John Lekakis
- 2nd Department of Cardiology, Attikon University Hospital , Athens , Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Athens University Medical School, Hippokration Hospital , Athens , Greece
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Lerario MP, Merkler AE, Gialdini G, Parikh NS, Navi BB, Kamel H. Risk of Stroke After the International Classification of Diseases-Ninth Revision Discharge Code Diagnosis of Hypertensive Encephalopathy. Stroke 2016; 47:372-5. [PMID: 26742804 DOI: 10.1161/strokeaha.115.011992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/10/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Although chronic hypertension is a well-established risk factor for stroke, little is known about stroke risk after hypertensive encephalopathy (HE), when neurologic sequelae of hypertension become evident. Therefore, we evaluated the risk of stroke after a diagnosis of HE. METHODS We identified all patients discharged from California, New York, and Florida emergency departments and acute care hospitals between 2005 and 2012 with a primary International Classification of Diseases, Ninth Edition, Clinical Modification discharge diagnosis of HE (437.2). Patients discharged with a primary diagnosis of seizure (345.x) served as negative controls, whereas patients with a primary diagnosis of transient ischemic attack (435.x) were positive controls. Our primary outcome was the composite of subsequent ischemic stroke or intracerebral hemorrhage. Kaplan-Meier survival statistics were used to calculate cumulative outcome rates, and Cox proportional hazard analysis was used to examine the association between index disease types and outcomes while adjusting for vascular risk factors. RESULTS We identified 8233 patients with HE, 191 091 with seizure, and 308 680 with transient ischemic attack. The 1-year cumulative rate of ischemic stroke or intracerebral hemorrhage after HE was 4.90% (95% confidence interval [CI], 4.45-5.40) when compared with 0.92% (95% CI, 0.88-0.97) after seizure and 4.49% (95% CI, 4.42-4.57) after transient ischemic attack. The risk of intracerebral hemorrhage was significantly elevated in those with HE (hazard ratio, 2.0; 95% CI, 1.7-2.5) but not in those with transient ischemic attack (hazard ratio, 1.0; 95% CI, 0.9-1.1), when compared with seizure patients. CONCLUSIONS Patients discharged with a diagnosis of HE face a high risk of future cerebrovascular events, particularly intracerebral hemorrhage.
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Affiliation(s)
- Michael P Lerario
- From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY.
| | - Alexander E Merkler
- From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY
| | - Gino Gialdini
- From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY
| | - Neal S Parikh
- From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY
| | - Babak B Navi
- From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY
| | - Hooman Kamel
- From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY
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Suzuki N, Suzuki K, Mizuno T, Kato Y, Suga N, Yoshino M, Miura N, Banno S, Imai H. Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives. Intern Med 2016; 55:83-8. [PMID: 26726092 DOI: 10.2169/internalmedicine.55.5500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being well-controlled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.
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Affiliation(s)
- Natsuko Suzuki
- Division of Nephrology and Rheumatology and Division of Cardiology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan
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28
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Sublingual vs. Oral Captopril in Hypertensive Crisis. J Emerg Med 2016; 50:108-15. [DOI: 10.1016/j.jemermed.2015.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 07/04/2015] [Accepted: 07/25/2015] [Indexed: 11/20/2022]
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Salkic S, Brkic S, Batic-Mujanovic O, Ljuca F, Karabasic A, Mustafic S. Emergency Room Treatment of Hypertensive Crises. Med Arch 2015; 69:302-6. [PMID: 26622081 PMCID: PMC4639340 DOI: 10.5455/medarh.2015.69.302-306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 11/03/2022] Open
Abstract
AIM The aim of the study was to evaluate efficiency of hypertensive urgency treatment using inhibitors of α1-adrenergic receptors and angiotensin converting enzyme inhibitors-ACE inhibitors in the Emergency Room of Outpatient Hospital and Polyclinic "dr Mustafa Šehovic" Tuzla in relation to age, duration and severity of hypertension. METHODS The study was conducted from June 2011 to May 2012 and included 120 patients of both sexes diagnosed with arterial hypertension, aged 40 to 80 with verified hypertensive urgency. The patients were divided into two groups: the control group treated with sublingual captopril and the experimental group treated intravenously with urapidil. RESULTS The results show that the largest number of patients belonged to age group from 60 to 69 years (34,16%), and the average age was 58 (11). The largest number of patients (38,0%) had verified hypertension for 11 to 20 years. The average systolic/diastolic artery blood pressure at reception was 213 (19) / 130 (4) mmHg. The average systolic/diastolic artery blood pressure after the first dose of 12,5 mg captopril in the control group was 177,42 (10,91) / 112,33 (3,50) mmHg, while after the first dose of 12,5 mg urapidil it was 179,25 (16,62) / 110,33 (8,78) mmHg. The average systolic/diastolic artery blood pressure after the second dose of 12,5 mg of captopril in the control group was 152,00 (6,32) / 95,50 (3,76) mmHg, while after the second dose of 12,5 mg of urapidil it was 152,55 (7,17) / 95,29 (5,04) mmHg. CONCLUSION Urapidil is more efficient in hypertensive urgency treatment, since the decrease of middle artery pressure (MAP) in the group treated with urapidil was statistically significant (p<0,001). No statistical significance was found between the efficiency of urapidil and the patient's age, while captopril was more efficient in older patients (p=0,02). Also, no statistically significant difference was found between the efficiency of captopril and urapidil in relation to duration of hypertension.
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Affiliation(s)
- Sabina Salkic
- Emergency Medical Service Department, Community Health Care Center Tuzla
| | - Selmira Brkic
- Department of Pathophysiology, Faculty of Medicine, University of Tuzla
| | | | - Farid Ljuca
- Department of Physiology, Faculty of Medicine, University of Tuzla
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30
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Baum L. A case of hypertensive urgency. J ROY ARMY MED CORPS 2015; 162:297-8. [PMID: 26002343 DOI: 10.1136/jramc-2015-000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
A 41-year-old male Nepalese soldier presented to the primary care medical centre with a 1-week history of fatigue and muscle aches following a trip to Nepal. His BP was 164/98 but was otherwise normal. Four days later he presented with new symptoms of sweating and palpitations and a BP of 200/127 whereupon he was admitted to hospital with the diagnosis of hypertensive crisis. Appropriate investigation and initial management were undertaken, and he was discharged after 12 h on antihypertensive treatment. This case highlights the risk of hypertensive crisis in both diagnosed and silent hypertensive disease, and the review highlights the presentations, initial investigation and different management of hypertensive crisis.
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Polgreen LA, Suneja M, Tang F, Carter BL, Polgreen PM. Increasing Trend in Admissions for Malignant Hypertension and Hypertensive Encephalopathy in the United States. Hypertension 2015; 65:1002-7. [DOI: 10.1161/hypertensionaha.115.05241] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/19/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Linnea A. Polgreen
- From the Departments of Pharmacy Practice and Science (L.A.P., B.L.C.), Internal Medicine (M.S.), Biostatistics (F.T.), Internal Medicine and Epidemiology (P.M.P.), and Family Medicine (B.L.C.), University of Iowa
| | - Manish Suneja
- From the Departments of Pharmacy Practice and Science (L.A.P., B.L.C.), Internal Medicine (M.S.), Biostatistics (F.T.), Internal Medicine and Epidemiology (P.M.P.), and Family Medicine (B.L.C.), University of Iowa
| | - Fan Tang
- From the Departments of Pharmacy Practice and Science (L.A.P., B.L.C.), Internal Medicine (M.S.), Biostatistics (F.T.), Internal Medicine and Epidemiology (P.M.P.), and Family Medicine (B.L.C.), University of Iowa
| | - Barry L. Carter
- From the Departments of Pharmacy Practice and Science (L.A.P., B.L.C.), Internal Medicine (M.S.), Biostatistics (F.T.), Internal Medicine and Epidemiology (P.M.P.), and Family Medicine (B.L.C.), University of Iowa
| | - Philip M. Polgreen
- From the Departments of Pharmacy Practice and Science (L.A.P., B.L.C.), Internal Medicine (M.S.), Biostatistics (F.T.), Internal Medicine and Epidemiology (P.M.P.), and Family Medicine (B.L.C.), University of Iowa
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Huang WS, Tseng CH, Lin CL, Lin CY, Sung FC, Kao CH. Risk of subsequent dementia in patients with hypertensive encephalopathy: a nationwide population-based study in Taiwan. Dement Geriatr Cogn Disord 2015; 37:357-65. [PMID: 24513673 DOI: 10.1159/000357701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We investigated the association of hypertensive encephalopathy (HE) with subsequent dementia. METHODS Using universal insurance claims data, we identified a study cohort of 5,504 participants with HE newly diagnosed between 1997 and 2010 and a comparison cohort of 22,016 healthy participants. Incidence and risks of dementia were estimated for both cohorts until the end of 2010. RESULTS The dementia incidence was 1.45-fold [95% confidence interval (CI) = 1.27-1.66] higher in the study cohort than in the comparison cohort, with an adjusted hazard ratio (HR) of 1.38 (95% CI = 1.19-1.59) for the study cohort. The risk was higher for males than for females and elderly patients. With an incidence of 13.4 per 1,000 person-years, the HR of dementia increased to 2.09 (95% CI = 1.18-3.71) for the HE patients with the comorbidities of head injury and diabetes compared to those without HE and comorbidities. The risk of developing dementia declined with the follow-up time. CONCLUSION Hypertensive patients with HE displayed a significantly higher risk for dementia than those without HE. The risk increased further in those with the comorbidities of head injury and diabetes. Physicians should be aware of the link between HE and dementia when assessing patients with HE.
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Affiliation(s)
- Wei-Shih Huang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
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Papadopoulos DP, Sanidas EA, Viniou NA, Gennimata V, Chantziara V, Barbetseas I, Makris TK. Cardiovascular Hypertensive Emergencies. Curr Hypertens Rep 2015; 17:5. [DOI: 10.1007/s11906-014-0515-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Padilla Ramos A, Varon J. Current and Newer Agents for Hypertensive Emergencies. Curr Hypertens Rep 2014; 16:450. [DOI: 10.1007/s11906-014-0450-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Manning L, Robinson TG, Anderson CS. Control of Blood Pressure in Hypertensive Neurological Emergencies. Curr Hypertens Rep 2014; 16:436. [DOI: 10.1007/s11906-014-0436-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fischer U, Cooney MT, Bull LM, Silver LE, Chalmers J, Anderson CS, Mehta Z, Rothwell PM. Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study. Lancet Neurol 2014; 13:374-84. [PMID: 24582530 PMCID: PMC4238109 DOI: 10.1016/s1474-4422(14)70031-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It is often assumed that blood pressure increases acutely after major stroke, resulting in so-called post-stroke hypertension. In view of evidence that the risks and benefits of blood pressure-lowering treatment in acute stroke might differ between patients with major ischaemic stroke and those with primary intracerebral haemorrhage, we compared acute-phase and premorbid blood pressure levels in these two disorders. Methods In a population-based study in Oxfordshire, UK, we recruited all patients presenting with stroke between April 1, 2002, and March 31, 2012. We compared all acute-phase post-event blood pressure readings with premorbid readings from 10-year primary care records in all patients with acute major ischaemic stroke (National Institutes of Health Stroke Scale >3) versus those with acute intracerebral haemorrhage. Findings Of 653 consecutive eligible patients, premorbid and acute-phase blood pressure readings were available for 636 (97%) individuals. Premorbid blood pressure (total readings 13 244) had been measured on a median of 17 separate occasions per patient (IQR 8–31). In patients with ischaemic stroke, the first acute-phase systolic blood pressure was much lower than after intracerebral haemorrhage (158·5 mm Hg [SD 30·1] vs 189·8 mm Hg [38·5], p<0·0001; for patients not on antihypertensive treatment 159·2 mm Hg [27·8] vs 193·4 mm Hg [37·4], p<0·0001), was little higher than premorbid levels (increase of 10·6 mm Hg vs 10-year mean premorbid level), and decreased only slightly during the first 24 h (mean decrease from <90 min to 24 h 13·6 mm Hg). By contrast with findings in ischaemic stroke, the mean first systolic blood pressure after intracerebral haemorrhage was substantially higher than premorbid levels (mean increase of 40·7 mm Hg, p<0·0001) and fell substantially in the first 24 h (mean decrease of 41·1 mm Hg; p=0·0007 for difference from decrease in ischaemic stroke). Mean systolic blood pressure also increased steeply in the days and weeks before intracerebral haemorrhage (regression p<0·0001) but not before ischaemic stroke. Consequently, the first acute-phase blood pressure reading after primary intracerebral haemorrhage was more likely than after ischaemic stroke to be the highest ever recorded (OR 3·4, 95% CI 2·3–5·2, p<0·0001). In patients with intracerebral haemorrhage seen within 90 min, the highest systolic blood pressure within 3 h of onset was 50 mm Hg higher, on average, than the maximum premorbid level whereas that after ischaemic stroke was 5·2 mm Hg lower (p<0·0001). Interpretation Our findings suggest that systolic blood pressure is substantially raised compared with usual premorbid levels after intracerebral haemorrhage, whereas acute-phase systolic blood pressure after major ischaemic stroke is much closer to the accustomed long-term premorbid level, providing a potential explanation for why the risks and benefits of lowering blood pressure acutely after stroke might be expected to differ. Funding Wellcome Trust, Wolfson Foundation, UK Medical Research Council, Stroke Association, British Heart Foundation, National Institute for Health Research.
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Affiliation(s)
- Urs Fischer
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marie Therese Cooney
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Linda M Bull
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Louise E Silver
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of Sydney, Australia
| | - Ziyah Mehta
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Salkic S, Batic-Mujanovic O, Ljuca F, Brkic S. Clinical presentation of hypertensive crises in emergency medical services. Mater Sociomed 2014; 26:12-6. [PMID: 24757394 PMCID: PMC3990398 DOI: 10.5455/msm.2014.26.12-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/29/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objective of this study is to evaluate the incidence and clinical presentation of hypertensive crises in the Emergency medical services of the Community Health Centre "Dr. Mustafa Šehović" Tuzla in relation to age, sex, duration and severity of hypertension, as well as the prevalence of accompanying symptoms and clinical manifestations. METHODS The study was conducted between November 2009 and April 2010 and included 180 subjects of both sexes, aged 30-80 with a diagnosis of arterial hypertension. All subjects were divided into two groups: a control group, which consisted of subjects without hypertensive crisis (95 subjects) and an experimental group that consisted of subjects with hypertensive crisis (85 subjects). RESULTS The study results indicate that female subjects were significantly over- represented compared to men (60% vs. 40 %, p=0.007). The average age of the male subjects was 55.83±11.06 years, while the female subjects' average age was 59.41±11.97 years. The incidence of hypertensive crisis was 47.22%, with hypertensive urgency significantly more represented than emergency (16.47% vs. 83.53%, p<0.0001). The majority of subjects in the experimental group (28.23%) belonged to the age group of 60-69 years of age: 26.76% urgency and 35.71% emergency. The most common accompanying symptoms in hypertensive subjects were headache (75%), chest pain (48.33%), vertigo (44.44%), shortness of breath (38.88%) and nausea (33.89%). The most common symptoms in subjects with hypertensive crisis were headache (74.11%), chest pain and shortness of breath (62.35%), vertigo (49.41%), and nausea and vomiting (41.17%). CONCLUSIONS Chest pain, shortness of breath, nausea and vomiting were significantly over-represented in subjects with hypertensive crisis (p<0.005). Clinical manifestations of hypertensive emergencies in almost all subjects included acute coronary syndrome, and only one subject had acute pulmonary edema.
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Affiliation(s)
- Sabina Salkic
- Emergency medical services, Community Health Centre Tuzla
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Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi. Int J Chronic Dis 2014; 2014:413071. [PMID: 26464857 PMCID: PMC4590913 DOI: 10.1155/2014/413071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 11/21/2022] Open
Abstract
Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.
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Edvardsson B. Hypertensive encephalopathy and cerebral infarction. SPRINGERPLUS 2014; 3:741. [PMID: 25932363 PMCID: PMC4409617 DOI: 10.1186/2193-1801-3-741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022]
Abstract
Introduction Hypertensive encephalopathy is one cause of posterior reversible encephalopathy syndrome. Hypertensive encephalopathy and cerebral infarction have only been reported in a few individual case reports. Case description A 51-year-old woman presented with hypertensive encephalopathy. T2-weighted images from magnetic resonance imaging showed hyperintense lesions in both occipital and parietal lobes. Diffusion-weighted imaging showed that this represented cytotoxic oedema and perfusion magnetic resonance imaging revealed reduced blood volume and flow. The magnetic resonance imaging was repeated 5 months later and subtotal regression of theT2-hyperintensity had occurred. However, small bilateral infarcts were seen on T1-weighted images. Perfusion magnetic resonance imaging presented reduced blood volume and flow on the right side. Discussion and evaluation The patient in this report had posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy. Magnetic resonance imaging of the brain showed bilateral cytotoxic oedema that partially resolved and resulted in small infarcts. The imaging findings are compatible with posterior reversible encephalopathy syndrome with subtotal resolution and infarct evolution. Conclusion The case report suggests that the presence of hypertensive encephalopathy and posterior reversible encephalopathy syndrome should alert clinicians and lead to prompt treatment in order to prevent cerebral damage.
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Affiliation(s)
- Bengt Edvardsson
- Department of Clinical Sciences, Lund, Neurology, Skane University Hospital, Lund University, S-221 85 Lund, Sweden
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Chung TT, Lin CY, Huang WY, Lin CL, Sung FC, Kao CH. Risks of subsequent epilepsy among patients with hypertensive encephalopathy: a nationwide population-based study. Epilepsy Behav 2013; 29:374-8. [PMID: 24090775 DOI: 10.1016/j.yebeh.2013.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND To determine whether the diagnosis of hypertensive encephalopathy (HE) is linked to an increased risk of subsequent epilepsy by using a nationwide population-based retrospective study. METHODS Our study featured a study cohort and a comparison cohort. The study cohort consisted of all patients with newly diagnosed HE between 1997 and 2010, compiled from universal insurance claims data on patients with hypertension taken from the National Health Insurance Research Database. The comparison cohort comprised the remaining hypertensive patients without encephalopathy. The follow-up period was terminated following the development of epilepsy, death, withdrawal from the National Health Insurance system, or the end of 2010. We determined the cumulative incidences and hazard ratios (HRs) of epilepsy development. RESULTS The incidence of subsequent epilepsy was 2.25-fold higher in the patients with HE than in comparisons (4.17 vs. 1.85 per 1000 person-years), with an adjusted HR of 2.06 (95% CI=1.66-2.56) in the multivariable Cox proportional-hazards regression analysis. The incidence of epilepsy was higher in men, younger patients with HE, and those with brain disorders. CONCLUSIONS We found that, in Taiwan, patients with HE are at an increased risk of subsequent epilepsy. Physicians should be aware of HE's link to epilepsy when assessing patients with HE.
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Affiliation(s)
- Tzu-Tsao Chung
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Davis TK, Halabi CM, Siefken P, Karmarkar S, Leonard J. Aggressive blood pressure control for chronic kidney disease unmasks moyamoya! Clin Kidney J 2013; 6:495-9. [PMID: 26064513 PMCID: PMC4438405 DOI: 10.1093/ckj/sft090] [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: 06/16/2013] [Accepted: 07/05/2013] [Indexed: 11/14/2022] Open
Abstract
Hypertensive crises in children or adolescents are rare, but chronic kidney disease (CKD) is a major risk factor for occurrence. Vesicoureteral reflux nephropathy is a common cause of pediatric renal failure and is associated with hypertension. Aggressive blood pressure (BP) control has been shown to delay progression of CKD and treatment is targeted for the 50th percentile for height when compared with a target below the 90th percentile for the general pediatric hypertensive patient. We present a case of an adolescent presenting with seizures and renal failure due to a hypertensive crisis. Hypertension was thought to be secondary to CKD as she had scarred echogenic kidneys due to known reflux nephropathy. However, aggressive BP treatment improved kidney function which is inconsistent with CKD from reflux nephropathy. Secondly, aggressive BP control caused transient neurological symptoms. Further imaging identified moyamoya disease. We present this case to highlight the consideration of moyamoya as a diagnosis in the setting of renal failure and hypertensive crisis.
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Affiliation(s)
- T Keefe Davis
- Department of Pediatrics (Division of Nephrology) , Washington University School of Medicine , St. Louis, MO , USA
| | - Carmen M Halabi
- Department of Pediatrics (Division of Nephrology) , Washington University School of Medicine , St. Louis, MO , USA
| | - Philp Siefken
- Department of Internal Medicine and Pediatrics , Greenville Regional Hospital , Greenville, IL , USA
| | - Swati Karmarkar
- Department of Neurology (Division of Developmental and Pediatric Neurology) , Washington University School of Medicine , St. Louis, MO , USA
| | - Jeffrey Leonard
- Department of Neurological Surgery (Division of Pediatric Neurosurgery) , Washington University School of Medicine , St. Louis, MO , USA
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Dinc M, Balta S, Demirkol S, Cakar M, Akhan M, Sarlak H. The Relationship Between Hypertensive Crisis and Patient Outcome. J Clin Hypertens (Greenwich) 2013; 15:608. [DOI: 10.1111/jch.12137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mustafa Dinc
- Department of Internal Medicine; Beytepe Military Hospital; Ankara Turkey
| | - Sevket Balta
- Department of Cardiology; Gulhane Medical Academy; Ankara Turkey
| | - Sait Demirkol
- Department of Cardiology; Gulhane Medical Academy; Ankara Turkey
| | - Mustafa Cakar
- Department of Internal Medicine; Gulhane Medical Academy; Ankara Turkey
| | - Muharrem Akhan
- Department of Internal Medicine; Gulhane Medical Academy; Ankara Turkey
| | - Hakan Sarlak
- Department of Internal Medicine; Gulhane Medical Academy; Ankara Turkey
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Salgado DR, Silva E, Vincent JL. Control of hypertension in the critically ill: a pathophysiological approach. Ann Intensive Care 2013; 3:17. [PMID: 23806076 PMCID: PMC3704960 DOI: 10.1186/2110-5820-3-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/14/2013] [Indexed: 01/21/2023] Open
Abstract
Severe acute arterial hypertension can be associated with significant morbidity and mortality. After excluding a reversible etiology, choice of therapeutic intervention should be based on evaluation of a number of factors, such as age, comorbidities, and other ongoing therapies. A rational pathophysiological approach should then be applied that integrates the effects of the drug on blood volume, vascular tone, and other determinants of cardiac output. Vasodilators, calcium channel blockers, and beta-blocking agents can all decrease arterial pressure but by totally different modes of action, which may be appropriate or contraindicated in individual patients. There is no preferred agent for all situations, although some drugs may have a more attractive profile than others, with rapid onset action, short half-life, and fewer adverse reactions. In this review, we focus on the main mechanisms underlying severe hypertension in the critically ill and how using a pathophysiological approach can help the intensivist decide on treatment options.
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Affiliation(s)
- Diamantino Ribeiro Salgado
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium
- Dept of Internal Medicine, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255 Sala 4A, Rio de Janeiro 12-21941-913, Brazil
| | - Eliezer Silva
- Intensive Care Unit, Albert Einstein Hospital, Sao Paulo, Brazil
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium
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González Pacheco H, Morales Victorino N, Núñez Urquiza JP, Altamirano Castillo A, Juárez Herrera U, Arias Mendoza A, Azar Manzur F, Briseño de la Cruz JL, Martínez Sánchez C. Patients with hypertensive crises who are admitted to a coronary care unit: clinical characteristics and outcomes. J Clin Hypertens (Greenwich) 2013; 15:210-4. [PMID: 23458594 PMCID: PMC8033841 DOI: 10.1111/jch.12058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 11/08/2012] [Accepted: 11/16/2012] [Indexed: 11/28/2022]
Abstract
Patients with hypertensive crises, especially hypertensive emergencies, require immediate admittance to an intensive care unit for rapid blood pressure (BP) control. The authors analyzed the prevalence of hypertensive crisis, the clinical characteristics, and the evolution of patients with hypertensive emergencies and urgencies. Patients were divided into 3 groups according to their BP values: group I, predominant systolic hypertension (≥180/≤119 mm Hg); group II, severe systolic and diastolic hypertension (≥180/≥120 mm Hg); and group III, predominant diastolic hypertension (≤179/≥120 mm Hg). Of all of the patients admitted to a coronary care unit, 538 experienced a hypertensive crisis, which represented 5.08% of all admissions. Hypertensive emergency was predominant in 76.6% of the cases, which corresponded to acute coronary syndrome and acute decompensated heart failure in 59.5% and 25.2% of the cases, respectively. A pattern of predominant systolic hypertension (≥180/≤119 mm Hg) was most commonly observed in the hypertensive crisis group (71.4%) and the hypertensive emergency group (72.1%). The medications that were most commonly used at onset included intravenous vasodilators (nitroglycerin in 63.4% and sodium nitroprusside in 16.4% of the patients). The overall mortality rate was 3.7%. The mortality rate was 4.6% for hypertensive emergency cases and 0.8% for hypertensive urgencies cases.
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Thulasi P, Fraser CL, Biousse V, Wright DW, Newman NJ, Bruce BB. Nonmydriatic ocular fundus photography among headache patients in an emergency department. Neurology 2013; 80:432-7. [PMID: 23284060 PMCID: PMC3590046 DOI: 10.1212/wnl.0b013e31827f0f20] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/26/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Determine the frequency of and the predictive factors for abnormal ocular fundus findings among emergency department (ED) headache patients. METHODS Cross-sectional study of prospectively enrolled adult patients presenting to our ED with a chief complaint of headache. Ocular fundus photographs were obtained using a nonmydriatic fundus camera that does not require pupillary dilation. Demographic and neuroimaging information was collected. Photographs were reviewed independently by 2 neuroophthalmologists for findings relevant to acute care. The results were analyzed using univariate statistics and logistic regression modeling. RESULTS We included 497 patients (median age: 40 years, 73% women), among whom 42 (8.5%, 95% confidence interval: 6%-11%) had ocular fundus abnormalities. Of these 42 patients, 12 had disc edema, 9 had optic nerve pallor, 6 had grade III/IV hypertensive retinopathy, and 15 had isolated retinal hemorrhages. Body mass index ≥ 35 kg/m(2) (odds ratio [OR]: 2.3, p = 0.02), younger age (OR: 0.7 per 10-year increase, p = 0.02), and higher mean arterial blood pressure (OR: 1.3 per 10-mm Hg increase, p = 0.003) were predictive of abnormal retinal photography. Patients with an abnormal fundus had a higher percentage of hospital admission (21% vs 10%, p = 0.04). Among the 34 patients with abnormal ocular fundi who had brain imaging, 14 (41%) had normal imaging. CONCLUSIONS Ocular fundus abnormalities were found in 8.5% of patients with headache presenting to our ED. Predictors of abnormal funduscopic findings included higher body mass index, younger age, and higher blood pressure. Our study confirms the importance of funduscopic examination in patients with headache, particularly in the ED, and reaffirms the utility of nonmydriatic fundus photography in this setting.
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Affiliation(s)
- Praneetha Thulasi
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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Sarafidis PA, Georgianos PI, Malindretos P, Liakopoulos V. Pharmacological management of hypertensive emergencies and urgencies: focus on newer agents. Expert Opin Investig Drugs 2012; 21:1089-106. [PMID: 22667825 DOI: 10.1517/13543784.2012.693477] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hypertensive crises are categorized as hypertensive emergencies and urgencies depending on the presence of acute target-organ damage; the former are potentially life-threatening medical conditions, requiring urgent treatment under close monitoring. Although several short-acting intravenous antihypertensive agents are approved for this purpose, until recently little evidence from proper trials on the relative merits of different therapies was available. AREAS COVERED This article discusses in brief the pathophysiology, epidemiology and diagnostic approach of hypertensive crises and provides an extensive overview of established and emerging pharmacological agents for the treatment of patients with hypertensive emergencies and urgencies. EXPERT OPINION Agents such as sodium nitroprusside, nitroglycerin and hydralazine have been used for many years as first-line options for patients with hypertensive emergencies, although their potential adverse effects and difficulties in use were well known. With time, equally potent and less toxic alternatives, including nicardipine, fenoldopam, labetalol and esmolol are increasingly used worldwide. Recently, clevidipine, a third-generation dihydropyridine calcium-channel blocker with unique pharmacodynamic and pharmacokinetic properties was added to our therapeutic armamentarium and was shown in clinical trials to reduce mortality when compared with nitroprusside. In view of such evidence, a change in pharmacological treatment practices for hypertensive crises toward newer and safer agents is warranted.
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Affiliation(s)
- Pantelis A Sarafidis
- Aristotle University of Thessaloniki, AHEPA Hospital, 1st Department of Medicine, Section of Nephrology and Hypertension, Thessaloniki, Greece.
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Miller CP, Cook AM, Pharm D, Case CD, Bernard AC. As-Needed Antihypertensive Therapy in Surgical Patients, Why and How: Challenging a Paradigm. Am Surg 2012. [DOI: 10.1177/000313481207800247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertension is common in hospitalized patients and there are many causes. Some patients have no prior history of hypertension, few symptoms, and no apparent morbidity related to acute rises in blood pressure. Though there is no established guideline for therapy in these cases, patients often receive therapy directed at the abnormal vital sign. It is hypothesized that this practice is common and the associated costs are significant. Using the inpatient pharmacy database at the University of Kentucky Chandler Medical Center, a verified Level I trauma center and quaternary referral center, patients on the emergency general surgery or orthopedic surgery services receiving intravenous hydralazine, metoprolol, or labetalol were identified. Subjects were analyzed for indications, parameters, associated history of hypertension, and direct costs. Over the 4-month study period, 114 subjects received 522 drug doses. More than half (55%) of subjects had a prior history of hypertension but only 75 per cent were started on their home medication. Of those without hypertension before admission, 18 per cent required therapy at discharge. Labetalol was the most frequently used agent and total pharmacy costs for this cohort of patients was over $1200. Pro re nata (PRN), short-acting antihypertensive therapy has little evidence base in asymptomatic patients, but its prevalence is high on surgical services. The cost is significant, especially when extrapolated to the larger hospital population at this single institution. Further research is warranted to determine the prevalence of this practice in other centers or national regions, as well as its cost and benefit.
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Affiliation(s)
- Christopher P. Miller
- Section on Acute Care Surgery and Trauma, Department of Surgery, University of Kentucky Healthcare, Lexington, Kentucky and the, Lexington, Kentucky
| | - Aaron M. Cook
- Section on Acute Care Surgery and Trauma, Department of Surgery, University of Kentucky Healthcare, Lexington, Kentucky and the, Lexington, Kentucky
| | - D. Pharm
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky
| | - Christopher D. Case
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky
| | - Andrew C. Bernard
- Section on Acute Care Surgery and Trauma, Department of Surgery, University of Kentucky Healthcare, Lexington, Kentucky and the, Lexington, Kentucky
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Becker DE, Haas DA. Recognition and management of complications during moderate and deep sedation. Part 2: cardiovascular considerations. Anesth Prog 2011; 58:126-38. [PMID: 21882989 DOI: 10.2344/0003-3006-58.3.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The risk for cardiovascular complications while providing any level of sedation or general anesthesia is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, providers must be prepared to manage untoward events should they arise. This continuing education article will review cardiovascular complications and address their appropriate management.
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