1
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Sethi SK, S S, Nair A, Soni K, Bihari Bansal S, Rana AS, Raina R. What came first, atypical hemolytic uremic syndrome or malignant hypertension: a clinical dilemma. Ren Fail 2024; 46:2327484. [PMID: 38466192 DOI: 10.1080/0886022x.2024.2327484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
- Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Savita S
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Aishwarya Nair
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Kritika Soni
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | | | - Abhyuday S Rana
- Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Rupesh Raina
- Pediatric Nephrology, Akron Children's Hospital, Akron, Ohio, USA
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2
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Sattarova V, Flowers A, Gospe SM, Chen JJ, Stunkel L, Bhatti MT, Dattilo M, Kedar S, Biousse V, McClelland CM, Lee MS. A multi-centre case series of patients with coexistent intracranial hypertension and malignant arterial hypertension. Eye (Lond) 2024; 38:274-278. [PMID: 37491440 PMCID: PMC10811224 DOI: 10.1038/s41433-023-02672-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To describe the clinical characteristics, outcomes, and management of a large cohort of patients with concomitant malignant arterial hypertension and intracranial hypertension. METHODS Design: Retrospective case series. SUBJECTS Patients aged ≥ 18 years with bilateral optic disc oedema (ODE), malignant arterial hypertension and intracranial hypertension at five academic institutions. Patient demographics, clinical characteristics, diagnostic studies, and management were collected. RESULTS Nineteen patients (58% female, 63% Black) were included. Median age was 35 years; body mass index (BMI) was 30 kg/m2. Fourteen (74%) patients had pre-existing hypertension. The most common presenting symptom was blurred vision (89%). Median blood pressure (BP) was 220 mmHg systolic (IQR 199-231.5 mmHg) and 130 mmHg diastolic (IQR 116-136 mmHg) mmHg), and median lumbar puncture opening pressure was 36.5 cmH2O. All patients received treatment for arterial hypertension. Seventeen (89%) patients received medical treatment for raised intracranial pressure, while six (30%) patients underwent a surgical intervention. There was significant improvement in ODE, peripapillary retinal nerve fibre layer thickness, and visual field in the worst eye (p < 0.05). Considering the worst eye, 9 (47%) presented with acuity ≥ 20/25, while 5 (26%) presented with ≤ 20/200. Overall, 7 patients maintained ≥ 20/25 acuity or better, 6 demonstrated improvement, and 5 demonstrated worsening. CONCLUSIONS Papilloedema and malignant arterial hypertension can occur simultaneously with potentially greater risk for severe visual loss. Clinicians should consider a workup for papilloedema among patients with significantly elevated blood pressure and bilateral optic disc oedema.
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Affiliation(s)
- Victoria Sattarova
- Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA
| | - Alexis Flowers
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, USA
| | - Sidney M Gospe
- Department of Ophthalmology Duke University, Durham, USA
| | - John J Chen
- Departments of Ophthalmology and Neurology Mayo Clinic College of Medicine, Rochester, USA
| | - Leanne Stunkel
- Department of Ophthalmology and Visual Sciences Washington University in St. Louis, St. Louis, USA
| | - M Tariq Bhatti
- Department of Ophthalmology The Permanente Medical Group Northern California, California, USA
| | - Michael Dattilo
- Department of Ophthalmology Emory University, Atlanta, Georgia
| | - Sachin Kedar
- Department of Ophthalmology Emory University, Atlanta, Georgia
- Department of Neurology Emory University, Atlanta, Georgia
| | - Valerie Biousse
- Department of Ophthalmology Emory University, Atlanta, Georgia
- Department of Neurology Emory University, Atlanta, Georgia
| | - Collin M McClelland
- Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA
| | - Michael S Lee
- Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA.
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3
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Palani S, Rinita D, Salman A. Atypical presentation of malignant hypertension. BMJ Case Rep 2023; 16:e255723. [PMID: 38061857 PMCID: PMC10711926 DOI: 10.1136/bcr-2023-255723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
A woman in her 30s presented with complaints of sudden onset of defective vision in the right eye for 2 days, with history of headache for a month. On examination, best corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Anterior segment examination was normal. Fundus examination of both the eyes showed generalised arteriolar attenuation with diffuse, hyperaemic disc oedema and serous retinal detachment at macula in the right eye. Her blood pressure (BP) was 230/140 mm Hg. Other systemic evaluation was unremarkable. In the review visit, patient's BP reduced to 140/100 mm Hg, and visual acuity in the right eye improved to 20/20. Fundus in the right eye showed resolving disc oedema with macular star formation, and the left eye had developed soft exudates. This seemed to confirm the diagnosis of the disc oedema being caused by hypertension and a highly asymmetrical presentation of hypertensive retinopathy.
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Affiliation(s)
- Subashree Palani
- Ophthalmology, Karpaga Vinayaga Institute of Medical Science and Research Center, Maduranthagam, Tamil Nadu, India
| | - Deborah Rinita
- Ophthalmology, Shri Sathya Sai Medical College and Research Institute, Nellikuppam, Tamil Nadu, India
| | - Amjad Salman
- Retina, Institute of Ophthalmology Joseph Eye Hospital, Tiruchirappalli, Tamil Nadu, India
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4
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Kulkarni S, Glover M, Kapil V, Abrams SML, Partridge S, McCormack T, Sever P, Delles C, Wilkinson IB. Management of hypertensive crisis: British and Irish Hypertension Society Position document. J Hum Hypertens 2023; 37:863-879. [PMID: 36418425 PMCID: PMC10539169 DOI: 10.1038/s41371-022-00776-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022]
Abstract
Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by British and Irish Hypertension Society, aims to provide clinicians a framework for diagnosing, evaluating, and managing patients with hypertensive crisis, based on the critical appraisal of available evidence and expert opinion.
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Affiliation(s)
- Spoorthy Kulkarni
- Department of Clinical Pharmacology and Therapeutics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB20QQ, UK.
| | - Mark Glover
- Division of Therapeutics and Molecular Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, Queen Mary University London, London, EC1M 6BQ, UK
- Barts BP Centre of Excellence, Barts Heart Centre, London, EC1A 7BE, UK
| | - S M L Abrams
- Clinical Pharmacology and Therapeutics, Homerton Healthcare NHS Foundation Trust, London, E9 6SR, UK
| | - Sarah Partridge
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, BN1 9PH, UK
| | - Terry McCormack
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, HU6 7RX, UK
| | - Peter Sever
- Imperial College School of Medicine, London, SW7 1LY, UK
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, UK
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, CB2 0QQ, UK
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5
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Murai S, Kakeshita K, Imamura T, Koike T, Fujioka H, Yamazaki H, Kinugawa K. Malignant Hypertension and Bilateral Primary Aldosteronism. Intern Med 2023; 62:2675-2680. [PMID: 36725041 PMCID: PMC10569932 DOI: 10.2169/internalmedicine.1098-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/18/2022] [Indexed: 02/03/2023] Open
Abstract
Malignant hypertension triggers incremental renin activity, whereas primary aldosteronism suppresses such activity. We encountered a patient with malignant hypertension refractory to multiple anti-hypertensive agents. Repeated neurohormonal assessments, instead of a single one, eventually uncovered trends in an incremental aldosterone concentration, ranging from 221 up to 468 pg/mL, with a decline in the renin activity from 2.3 to <0.2 ng/mL/h. Adrenal venous sampling confirmed bilateral aldosterone secretion. Following the diagnosis of bilateral primary aldosteronism, we initiated a mineralocorticoid receptor antagonist, which improved his blood pressure. Repeated neurohormonal assessments are encouraged to correctly diagnose underlying primary aldosteronism with malignant hypertension.
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Affiliation(s)
- Sayaka Murai
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Japan
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6
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Gupta V, Luthra S, Puthalath AS, Chauhan U. Undiagnosed malignant hypertension presenting as a direct spontaneous carotid-cavernous fistula with complete loss of vision and hyphaema. BMJ Case Rep 2022; 15:e246243. [PMID: 35210224 PMCID: PMC8883199 DOI: 10.1136/bcr-2021-246243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vinita Gupta
- Department of Ophthalmology, AIIMS Rishikesh, Rishikesh, India
| | - Saurabh Luthra
- Department of Ophthalmology, Drishti Eye Institute, Dehradun, India
| | | | - Udit Chauhan
- Department of Ophthalmology, AIIMS Rishikesh, Rishikesh, India
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7
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Timmermans SAMEG, Wérion A, Damoiseaux JGMC, Morelle J, Reutelingsperger CP, van Paassen P. Diagnostic and Risk Factors for Complement Defects in Hypertensive Emergency and Thrombotic Microangiopathy. Hypertension 2019; 75:422-430. [PMID: 31865800 DOI: 10.1161/hypertensionaha.119.13714] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hypertensive emergency can cause thrombotic microangiopathy (TMA) in the kidneys with high rates of end-stage renal disease (ESRD) and vice versa. The conundrum of hypertension as the cause of TMA or consequence of TMA on the background of defects in complement regulation remains difficult. Patients with hypertensive emergency and TMA on kidney biopsy were tested for ex vivo C5b9 formation on the endothelium and rare variants in complement genes to identify complement-mediated TMA. We identified factors associated with defects in complement regulation and poor renal outcomes. Massive ex vivo C5b9 formation was found on resting endothelial cells in 18 (69%) out of 26 cases at the presentation, including the 9 patients who carried at least one rare genetic variant. Thirteen (72%, N=18) and 3 (38%, N=8) patients with massive and normal ex vivo complement activation, respectively, progressed to ESRD (P=0.03). In contrast to BP control, inhibition of C5 activation prevented ESRD to occur in 5 (83%, N=6) patients with massive ex vivo complement activation. TMA-related graft failure occurred in 7 (47%, N=15) donor kidneys and was linked to genetic variants. The assessment of both ex vivo C5b9 formation and screening for rare variants in complement genes may categorize patients with hypertensive emergency and TMA into different groups with potential therapeutic and prognostic implications. We propose an algorithm to recognize patients at the highest risk for defects in complement regulation.
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Affiliation(s)
- Sjoerd A M E G Timmermans
- From the Department of Nephrology and Clinical Immunology (S.A.M.E.G.T., P.v.P.), Cardiovascular Research Institute Maastricht, the Netherlands
- Department of Biochemistry (S.A.M.E.G.T., C.P.R., P.v.P.), Cardiovascular Research Institute Maastricht, the Netherlands
| | - Alexis Wérion
- Division of Nephrology, Cliniques universitaires Saint-Luc (A.W., J.M.)
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center (J.G.M.C.D.), Cardiovascular Research Institute Maastricht, the Netherlands
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc (A.W., J.M.)
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium (J.M.)
| | - Chris P Reutelingsperger
- Department of Biochemistry (S.A.M.E.G.T., C.P.R., P.v.P.), Cardiovascular Research Institute Maastricht, the Netherlands
| | - Pieter van Paassen
- From the Department of Nephrology and Clinical Immunology (S.A.M.E.G.T., P.v.P.), Cardiovascular Research Institute Maastricht, the Netherlands
- Department of Biochemistry (S.A.M.E.G.T., C.P.R., P.v.P.), Cardiovascular Research Institute Maastricht, the Netherlands
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8
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Aijazi I, Shama FA, Raman LG, Mukhtiar S. Malignant Hypertension Complicated By Renal Thrombotic Micro Angiopathy: Role Of Adam 13 Mutational Analyses. J Ayub Med Coll Abbottabad 2017; 29:502-505. [PMID: 29076694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a case of a 38-year-old U.A.E national who presented with malignant hypertension and features of thrombotic microangiopathy. He presented with oliguria, renal failure, thrombocytopenia and haemolytic anaemia. He required several sessions of renal replacement therapy. ADAM 13 mutational analysis was sent to differentiate Thrombotic micro angiopathy due to thrombotic thrombocytopenic purpura (TTP) or malignant hypertension. Renal biopsy revealed histopathological features of malignant arteriolar nephrosclerosis (MANS). Haemolytic parameters improved after control of blood pressure and he was subsequently discharged with early nephrology follow up.
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Affiliation(s)
- Ishma Aijazi
- Department of Internal Medicine and Histopathology, Dubai Hospital, Dubai, U.A.E
| | - Fadhil Al Shama
- Department of Internal Medicine and Histopathology, Dubai Hospital, Dubai, U.A.E
| | | | - Sara Mukhtiar
- Department of Internal Medicine and Histopathology, Dubai Hospital, Dubai, U.A.E
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9
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Malachias MVB, Barbosa ECD, Martim JFV, Rosito GBA, Toledo JY, Passarelli O. 7th Brazilian Guideline of Arterial Hypertension: Chapter 14 - Hypertensive Crisis. Arq Bras Cardiol 2017; 107:79-83. [PMID: 27819393 PMCID: PMC5319471 DOI: 10.5935/abc.20160164] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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10
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Abstract
Malignant or accelerated hypertension is the most severe form of hypertension, defined clinically by very high blood pressure (diastolic above 130 mm Hg) accompanied by bilateral retinal hemorrhages and/or exudates, with or without papilledema. The aim of this review is to discuss if malignant hypertension still poses a clinically relevant entity and to highlight the diagnostic challenges of this form of hypertension. The substantial improvement in prognosis in patients with malignant hypertension over the last decades is well documented, but there is no strong evidence to suggest a significant change in its incidence. In fact, with the growing population and improving life expectancy, malignant hypertension is likely to become even more prevalent worldwide, especially in the developing countries with less advanced health care services. Despite simple diagnostic criteria of malignant hypertension, the diagnoses may be difficult in many patients. Malignant hypertension patients often have the diagnosis established only when the target organ damage occur. Furthermore, retrospective diagnosis is problematic, as malignant hypertensive retinopathy gradually resolves over a relatively short period of time, while persistent target organ damage will, however, lead to the development of complications and much poorer prognosis than in nonmalignant hypertension patients. Certainly, malignant hypertension still poses a clinically relevant and challenging form of hypertension and its possibility should be always considered during the assessment of patients with poorly controlled hypertension.
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Affiliation(s)
- Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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11
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Santamaría R, Gorostidi M. [Hypertensive urgencies and emergencies]. Hipertens Riesgo Vasc 2017; 34 Suppl 2:35-38. [PMID: 29908665 DOI: 10.1016/s1889-1837(18)30074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hypertensive urgencies and emergencies are common situations in clinical practice. Hypertensive urgencies are characterized by acute elevation of blood pressure without target organ damage. Hypertensive emergencies are life-threatening situations characterized by acute elevation of blood pressure and target organ damage. The aims of blood pressure control, antihypertensive drugs to use and route of administration will depend on the presence or absence of target organ damage and individual patient characteristics. The correct diagnosis and treatment of these situations are essential for patient prognosis. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.
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Affiliation(s)
- R Santamaría
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España; Red de Investigación Renal (RedinRen)
| | - M Gorostidi
- Red de Investigación Renal (RedinRen); Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, España.
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12
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Abstract
A 49-year-old man with malignant hypertension, acute kidney injury and mental deterioration was referred to our hospital. We initially observed microangiopathic hemolytic anemia, thrombocytopenia and kidney damage, indicating he had thrombotic microangiopathy (TMA). We considered TMA was caused by malignant hypertension and therefore did not start plasma therapy. The French TMA reference center reported that platelet counts and serum creatine levels have high values for predicting severe ADAMTS13 deficiency. The patient fully recovered from his illness after treatment with antihypertensive drugs and intermittent hemodialysis. This case might thus be useful to understand the proper differential diagnosis and treatment of TMA.
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Affiliation(s)
- Hayato Mitaka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
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13
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Kryukov EV, Potekhin NP, Fursov AN, Chernetsov VA, Chernov SA, Zakharova EG. [HYPERTENSIVE CRISIS: MODERN VIEW OF THE PROBLEM AND OPTIMIZATION OF DIAGNOSTIC AND THERAPEUTIC MODALITIES]. Klin Med (Mosk) 2016; 94:52-56. [PMID: 27172724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The data collected by Burdenko Military Hospital indicate that in the 1980s hypertensive crisis (HC) occurred in roughly 30% of the patients with AH. This value fell down to 16% by 2012, with a rise in the number of uncomplicated crises from 46 to 62%. Analysis of the causes behind these changes showed that half of the patients simply experienced an elevated arterial pressure with minimal clinical symptoms. The decrease in the number of complicated cases from 54 to 39% is doubtful bearing in mind that ICD-10 gives the status of nosological entities to complications of hypertensive crisis (stroke, myocardial infarction, etc.) but not to the HC syndrome proper requiring urgent hospitalization; due to this hypertensive crisis itself tends to be disregarded and not included in statistics. HC with acute clinically significant lesions of target organs requires intensive care or resuscitation using infusion of vasodilators and loop diuretics to stabilize arterial pressure. In case of uncomplicted HC and aggravation of hypertensive disease, the medications of choice are oral short-acting ACE inhibitors and imidazoline receptor agonists.
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14
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Faber C, Nørgaard MH. [Malignant hypertension]. Ugeskr Laeger 2015; 177:V66466. [PMID: 26418709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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15
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Tripathy K, Chawla R. Bilateral exudative retinal detachment with choroidopathy in malignant hypertension. Natl Med J India 2015; 28:261. [PMID: 27132968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Koushik Tripathy
- Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi,
| | - Rohan Chawla
- Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi
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16
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Logee KM, Lakshminarayanan S. Scleroderma renal crisis as an initial presentation of systemic sclerosis: a case report and review of the literature. Clin Exp Rheumatol 2015; 33:S171-S174. [PMID: 25797912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 11/24/2014] [Indexed: 06/04/2023]
Abstract
Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis (SSc) that is characterised by new-onset malignant hypertension and progressive acute renal failure, often with associated microangiopathic haemolytic anaemia and thrombocytopenia. SRC was at one time almost uniformly fatal, with death often occurring within a few weeks. With the development of angiotensin-converting-enzyme inhibitors (ACE-I), survival has improved dramatically, but death rates still remain unacceptably high. About 20% of SRC cases occur prior to making a diagnosis of SSc and, in some cases, there is no evidence of skin sclerosis at the time that SRC develops. In this report, we present a case in which a patient developed SRC prior to being diagnosed with scleroderma. Additionally, we review the pathogenesis, presenting signs and symptoms, management and prognosis of SRC.
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MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/drug therapy
- Acute Kidney Injury/etiology
- Acute Kidney Injury/physiopathology
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/etiology
- Angiotensin II Type 1 Receptor Blockers/therapeutic use
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Antihypertensive Agents/therapeutic use
- Captopril/therapeutic use
- Delayed Diagnosis
- Drug Therapy, Combination
- Female
- Humans
- Hypertension, Malignant/diagnosis
- Hypertension, Malignant/drug therapy
- Hypertension, Malignant/etiology
- Hypertension, Malignant/physiopathology
- Middle Aged
- Predictive Value of Tests
- Renal Dialysis
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/drug therapy
- Tetrazoles/therapeutic use
- Thrombocytopenia/diagnosis
- Thrombocytopenia/etiology
- Time Factors
- Treatment Outcome
- Valine/analogs & derivatives
- Valine/therapeutic use
- Valsartan
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Affiliation(s)
- Kristin M Logee
- Division of Rheumatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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17
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18
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Affiliation(s)
- M Tomek
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Nandoskar
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - N Chapman
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Gabriel
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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19
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Stiefelhagen P. [Treatment refractory hypertension. When should an endocrine etiology be considered?]. MMW Fortschr Med 2014; 156 Spec No 1:20. [PMID: 24930338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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20
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Affiliation(s)
- David Hunt
- Edinburgh University, Edinburgh, United Kingdom
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21
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Hafidi Z, Daoudi R. L’atteinte oculaire au cours de l’hypertension artérielle maligne. Pan Afr Med J 2014; 17:9. [PMID: 25184026 PMCID: PMC4149793 DOI: 10.11604/pamj.2014.17.9.3804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Zouheir Hafidi
- Université Mohammed V Souissi, Service d'Ophtalmologie A de l'hôpital des spécialités, Centre Hospitalier Universitaire, Rabat, Maroc
- Corresponding author: Zouheir Hafidi, Université Mohammed V Souissi, Service d'Ophtalmologie A de l'hôpital des spécialités, Centre Hospitalier Universitaire, Rabat, Maroc. E-mail :
| | - Rajae Daoudi
- Université Mohammed V Souissi, Service d'Ophtalmologie A de l'hôpital des spécialités, Centre Hospitalier Universitaire, Rabat, Maroc
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22
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Yamada Y, Suzuki K, Nobata H, Kawai H, Wakamatsu R, Miura N, Banno S, Imai H. Gemcitabine-induced hemolytic uremic syndrome mimicking scleroderma renal crisis presenting with Raynaud's phenomenon, positive antinuclear antibodies and hypertensive emergency. Intern Med 2014; 53:445-8. [PMID: 24583433 DOI: 10.2169/internalmedicine.53.1160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman who received gemcitabine for advanced gallbladder cancer developed an impaired renal function, thrombocytopenia, Raynaud's phenomenon, digital ischemic changes, a high antinuclear antibody titer and hypertensive emergency that mimicked a scleroderma renal crisis. A kidney biopsy specimen demonstrated onion-skin lesions in the arterioles and small arteries along with ischemic changes in the glomeruli, compatible with a diagnosis of hypertensive emergency (malignant hypertension). The intravenous administration of a calcium channel blocker, the oral administration of an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker and the transfusion of fresh frozen plasma were effective for treating the thrombocytopenia and progressive kidney dysfunction. Gemcitabine induces hemolytic uremic syndrome with accelerated hypertension and Raynaud's phenomenon, mimicking scleroderma renal crisis.
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Affiliation(s)
- Yuichiro Yamada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan
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23
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Baguet JP. [Management of hypertension recorded as at least 180/110 mmHg]. Rev Prat 2013; 63:677-680. [PMID: 23789497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Stage 3 hypertension (severe) is far from rare. It may be part of a previous hypertension condition which is difficult to control, or occur more acutely, in which case it will be harder for the patient to bear. When it is symptomatic and a fortiorione or more organs targeted by hypertension are affected, management must be fast and appropriate. It may take the form of a hypertensive urgency, in which case the investigations and treatment usually take place in outpatients, with oral treatment. it may also be a hypertensive emergency for which treatment involves hospitalization in an intensive care unit with intravenous anti-hypertensive treatment. A reduction in blood pressure must be obtained rapidly but not suddenly; it must be more or less significant depending on the clinical situation, and also progressive.
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Affiliation(s)
- Jean-Philippe Baguet
- Unité d'hypertension artérielle, clinique de cardiologie, CHU de Grenoble, 38043 Grenoble Cedex 09, France.
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24
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Mourad JJ. [Severe hypertension: definition and patients profiles]. Rev Prat 2013; 63:672-676. [PMID: 23789495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Severe arterial hypertension gathers relatively different clinical situations explained by the heterogeneity of the definitions of this clinical setting. From a medical point of view, severe hypertension is a short course situation defined by very high values of blood pressure corresponding to grade 3 hypertension. In France, until 2011, the social security also included in the definition of severe HTA chronic situations characterized by moderate blood pressure values requiring at least triple anthihypertensive therapies associated with a clinical or infraclinical target organ damages. These clinical profiles, much more frequent than grade 3 hypertension, allowed the full reimbursement of care costs for these patients. In France, it is estimated that 10% of hypertensive patients present a severe form with an annual incidence of 50,000 patients. The patients with severe hypertension have an increased cardiovascular morbidity justifying a closer clinical monitoring. From an economic point of view, these severe forms of hypertension have a higher cost of care, explained primarily by a more frequent need of specialized referrals, radiological exams and hospitalizations. This excess cost justified the existence of a full coverage of induced costs by the social security, since the incidence of severe hypertension is more frequent in the low social categories, and in patients with economic fragility.
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Affiliation(s)
- Jean-Jacques Mourad
- Service de médecine interne et unité HTA, CHU Avicenne, AP-HP, 93000 Bobigny, France.
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25
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Briet M, Bobrie G, Azizi M. [Management of resistant hypertension]. Rev Prat 2013; 63:681-688. [PMID: 23789498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
High blood pressure is one of the leading factors influencing the cardiovascular risk. Despite current knowledge on the management of hypertension and the numerous antihypertensive drugs available, hypertension remains insufficiently controlled and part of these "uncontrolled" patients meet the definition of resistant hypertension. Resistant hypertension is defined by the failure of lowering blood pressure values to blood pressure target (office blood pressure < 140/90 or 130/80 mmHg in patients with diabetes or chronic kidney disease) despite appropriate treatment with optimal doses of three antihypertensive drugs from three different classes, one of which is a diuretic. Pseudoresistance should be excluded by using 24h ambulatory blood pressure or home blood pressure. The management of resistant hypertension includes the screening of secondary forms of hypertension and the identification of life style factors such as obesity, excessive alcohol and dietary sodium intake, volume overload, drug-induced hypertension. The treatment associates lifestyle changes, discontinuation of interfering substances, association of antihypertensive drugs on top of the initial triple therapy (including diuretic, blockers of the renin-angiotensin system and calcium channel blockers) ie aldosterone antagonists as fourth line treatment. New device-based approaches aiming to decrease the sympathetic tone including renal denervation and baroreceptor stimulation are under development.
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Affiliation(s)
- Marie Briet
- Université Paris-Descartes, Inserm, Centre d'investigation clinique 9201, Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France.
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26
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Vertkin AL, Topolianskiĭ AV, Abdullaeva AU, Alekseev MA, Shakhmanaev KA. [Hypertensive crisis: pathogenesis, clinic, treatment]. Kardiologiia 2013; 53:66-70. [PMID: 23953048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Contemporary data on mechanisms of development, types, and clinical picture of hypertensive crisis (HC) are presented. Algorithms of rational therapy of uncomplicated and complicated HC are considered. Appropriateness of the use in HC of antihypertensive drugs with multifactorial action is stressed. These drugs include urapidil - an antihypertensive agent with complex mechanism of action. Blocking mainly the postsynaptic 1-adrenoreceptors urapidil attenuates vasoconstrictor effect of catecholamines and decreases total peripheral resistance. Stimulation of 5HT1-receptors of medullary vasculomotor center promotes lowering of elevated vascular tone and prevents development of reflex tachycardia.
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27
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Nonaka K, Ubara Y, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Sawa N, Takaichi K, Kuroda Y, Oohashi K. Clinical and pathological evaluation of hypertensive emergency-related nephropathy. Intern Med 2013; 52:45-53. [PMID: 23291673 DOI: 10.2169/internalmedicine.52.7398] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The prognosis of patients with hypertensive emergencies has recently improved dramatically owing to the development of effective antihypertensive therapy. We examined the histological and clinical features of patients with hypertensive emergency-related nephropathy. METHODS Twelve patients (11 men and one woman) were diagnosed as having hypertensive emergencies with acute renal failure according to the Joint National Committee-7 classification of blood pressure for adults and underwent renal biopsies at our hospital between 1995 and 2008. These patients were enrolled in this retrospective study. RESULTS The age of the subjects was 40.1±9.8 years. At presentation, the mean systolic/diastolic blood pressure was 232±32/146±12 mmHg and none of the patients were being treated with antihypertensive drugs, although 10 patients had histories of hypertension. The mean serum creatinine level was 6.1±4.7 mg/dL. All 12 patients showed left ventricular hypertrophy on echocardiography. On light microscopy of the renal biopsy specimens, all 12 patients showed onion skin patterns of the arterioles; however, no fibrinoid necrosis of the small arteries was found. Electron microscopy revealed electron-lucent widening of the subendothelial zone of the glomerular capillary walls in seven patients. One of the 12 patients did not respond to medical therapy and required regular dialysis. The other 11 patients responded to treatment. CONCLUSION An onion skin pattern of the arterioles is the most frequent histological finding in patients with hypertensive emergency-related nephropathy. Long-standing hypertension might contribute to this arteriolar change, since left ventricular hypertrophy was also seen in these patients. With strict control of hypertension using antihypertensive medications, the prognosis of patients with hypertensive emergency-related nephropathy can be improved.
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Affiliation(s)
- Martin Middeke
- Hypertoniezentrum München, Hypertension Excellence Centre of the European Society of Hypertension (ESH) Herzzentrum Alter Hof München.
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30
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Park HS, Hong YA, Chung BH, Kim HW, Park CW, Yang CW, Jin DC, Kim YS, Choi BS. Malignant hypertension with an unusual presentation mimicking the immune mediated pulmonary renal syndrome. Yonsei Med J 2012; 53:1224-7. [PMID: 23074127 PMCID: PMC3481392 DOI: 10.3349/ymj.2012.53.6.1224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 27-year-old man presented at the emergency room with hemoptysis. His blood pressure was 180/100 mm Hg, and he had no history of hypertension. Chest radiographs showed bilateral infiltration, suggestive of alveolar hemorrhage. His laboratory data were consistent with acute kidney injury. His serum creatinine level increased abruptly; therefore, renal biopsy was performed. Steroid pulse therapy was administered because of a strong suspicion of immune-mediated pulmonary renal syndrome. Renal biopsy showed proliferative endarteritis, fibrinoid necrosis, and intraluminal thrombi in the vessels without crescent formation or necrotizing lesions. Steroid pulse therapy rapidly tapered and stopped. His serum creatinine level gradually decreased with strict blood pressure control. Ten months after discharge, his blood pressure was approximately 120/80 mm Hg with a serum creatinine level of 1.98 mg/dL. Pulmonary renal syndrome is generally caused by an immune-mediated mechanism. However, malignant hypertension accompanying renal insufficiency and heart dysfunction causing end-organ damage can create a pulmonary hemorrhage, similar to pulmonary renal syndrome caused by an immune-mediated mechanism. The present case shows that hypertension, a common disease, can possibly cause pulmonary renal syndrome, a rare condition.
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Affiliation(s)
- Hoon Suk Park
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Yu Ah Hong
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Hyung Wook Kim
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Dong Chan Jin
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Yong Soo Kim
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
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31
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Cacciapuoti F. Mitral annulus posterior systolic excursion instead of left ventricular ejection fraction to evaluate left ventricular systolic function both during urgent hypertensive crisis and after blood pressure normalization. J Clin Hypertens (Greenwich) 2012; 14:480. [PMID: 22747624 DOI: 10.1111/j.1751-7176.2012.00612.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Schmieder RE, Raff U. [Hypertensive crisis]. MMW Fortschr Med 2012; 154:56-57. [PMID: 22693759 DOI: 10.1007/s15006-012-0522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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33
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Marshall L, Shah P, Yeung S, Mundy J. Synchronous presentation of cardiac and abdominal paragangliomas. Ann Thorac Surg 2012; 93:e115-7. [PMID: 22541232 DOI: 10.1016/j.athoracsur.2011.11.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/07/2011] [Accepted: 11/28/2011] [Indexed: 12/24/2022]
Abstract
A 28-year-old male presenting with a hypertensive crisis was found to have synchronous right atrial and retrocaval masses. Serum normetadrenaline was elevated in keeping with functional paragangliomas. After preoperative optimization both masses were successfully excised, including a saphenous vein graft to the right coronary artery. Serum catecholamines returned to the normal range postoperatively and all antihypertensive therapy was ceased.
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Affiliation(s)
- Lachlan Marshall
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia.
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34
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Scrivano J, Giuliani A, Pettorini L, Punzo G, Mene' P, Pirozzi N. [Hypertensive crisis in kidney patients]. G Ital Nefrol 2011; 28:499-505. [PMID: 22028263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The classification and management of hypertensive crisis have been recently reviewed in the context of both European and American guidelines. The key points for proper blood pressure control in severe arterial hypertension are: 1 - Distinction between urgent intervention and emergencies 2 - Choice of the best drug(s) 3 - Choice of the correct route of administration. In patients with renal disease, beside the common causes of hypertension/ hypertensive crises, kidney-specific causes should be taken into account such as renal parenchymal hypertension, renovascular hypertension, sclerodermic crises, and preeclampsia.
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MESH Headings
- Angioplasty
- Antihypertensive Agents/therapeutic use
- Diagnosis, Differential
- Emergencies
- Female
- Humans
- Hypertension, Malignant/classification
- Hypertension, Malignant/complications
- Hypertension, Malignant/diagnosis
- Hypertension, Malignant/drug therapy
- Hypertension, Malignant/physiopathology
- Hypertension, Renal/etiology
- Hypertension, Renovascular/diagnosis
- Hypertension, Renovascular/surgery
- Hypnotics and Sedatives/therapeutic use
- Kidney Diseases/complications
- Kidney Diseases/physiopathology
- Pre-Eclampsia/physiopathology
- Pregnancy
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/physiopathology
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Affiliation(s)
- Jacopo Scrivano
- Dipartimento di Medicina Clinica e Molecolare, Facolta' di Medicina e Psicologia, Universita di Roma, Roma, Italy.
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35
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Choe JY, Park SH, Kim JY, Jung HY, Kim SK. A case of systemic lupus erythematosus presenting as malignant hypertension with hypertensive retinopathy. Korean J Intern Med 2010; 25:341-4. [PMID: 20830234 PMCID: PMC2932950 DOI: 10.3904/kjim.2010.25.3.341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 10/11/2007] [Accepted: 12/03/2007] [Indexed: 11/27/2022] Open
Abstract
The variability of cardiovascular abnormalities is one of the characteristics of systemic lupus erythematosus (SLE). Among the cardiovascular manifestations, hypertension is reported in 14% to 58.1% of patients in diverse ethnic populations, and remains a clinically important issue due to its close relationship with early mortality in patients with SLE. The development of hypertension in patients with SLE has been associated with advanced lupus-related renal disease and the medications used for the treatment of lupus. Malignant hypertension is a serious complication of hypertension; it rarely occurs in patients with SLE. However, it can occur in patients with other complicated medical conditions such as the antiphospholipid antibody syndrome (APS) or cardiac tamponade. Here, we report the case of a patient with SLE and malignant hypertension with hypertensive retinopathy that initially presented without clinical evidence of APS or hypertensive nephropathy.
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Affiliation(s)
- Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ji-Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun-Young Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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36
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Lindner UK. [Recognizing and understanding disorders: hypertension as the leading symptom]. Pflege Z 2010; 63:436-438. [PMID: 20677695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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37
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Morović-Vergles J, Culo MI, Kaliterna DM. [Scleroderma renal crisis]. Reumatizam 2010; 57:109-111. [PMID: 21875014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Systemic sclerosis (SSc) is a multisystem disease whose clinical manifestations result from inflammation, vascular injury and obliteration, and cutaneous and visceral fibrosis. Scleroderma renal crisis (SRC) occurs in 5% of patients with particullary diffuse form of SSc. It is characterized by malignant hypertension and oligo/ anuric acute renal failure. SRC was once a uniformly fatal complication of SSc. The prognosis of SRC has significantly improved with the introduction of angiotensin-converting enzyme inhibitors (ACEi) as treatment. The treatment of SRC relies on tight control of blood pressure and aggressive treatment with ACEi, if needed in combination with other types of antihypertensive drugs.
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38
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Quiñones Ortiz L, Suárez Laurés A, Pobes Martínez A, Torres Lacalle A. [Haemospermia in malignant hypertension]. Nefrologia 2010; 30:266. [PMID: 20393631 DOI: 10.3265/nefrologia.pre2010.mar.10345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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39
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Karakizlis H. [Hypertensive emergency in a 65-year-old patient. Noncompliance in taking antihypertensive drugs]. MMW Fortschr Med 2009; 151:20. [PMID: 20043387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
A follow-up was made of 69 patients diagnosed as having malignant hypertension during 1969--76, essential in 26, secondary in 39 and unclassified in 4. A clear male dominance was seen (41 men, 28 women), particularly in the group with essential hypertension (18 men, 8 women). The mortality in this series was less than in previously published series. Thus, the 5-year survival rate was 75% in the patients with essential and 72% in those with secondary hypertension. In part this was due to haemodialysis and renal transplantation. The importance of renal function at the time of diagnosis was evident in this study. In most patients with essential hypertension and serum creatinine levels below 300 mumol/l, renal function could be maintained or improved when antihypertensive treatment was instituted, whereas progression of the renal damage was seen in those with serum creatinine levels above 300 mumol/l in spite of antihypertensive treatment with 3 or more drugs. The incidence of new cases of malignant hypertension tended to decrease during the observation period, particularly as regards essential hypertension.
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Pergolini MS. The management of hypertensive crises: a clinical review. Clin Ter 2009; 160:151-157. [PMID: 19452106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hypertension is an exceedingly common disorder in Western societies; but, thanks to improved management of chronic hypertension, the number of patients who present with hypertensive crisis (HC) is less than 1%. However, critical elevation of blood pressure (BP) obliges to a proper and immediate management in order to prevent serious injury to organ target of hypertension (brain, heart, kidney and vessels). Moreover, the so called hypertensive emergencies (HE) and the hypertensive urgencies (HU) expect a several therapeutic approach. The HE warrant both prompt admission to an intensive care unit, where it is available a continuous monitoring of BP, and a prompt starting of a therapy with parenteral anti-hypertensive drugs. The treatment of HU can be managed choosing oral anti-hypertensive agents followed by a tight observation of the patient also in ambulatory system, lowering the BP more gradually over 12 to 24-48 hours. The present clinical review is aimed at reporting the current opinions on the management of HC, examining as well the drugs of largest use. Any drug that lowers BP precipitously should be avoided. Choice of the appropriate agent should be based on the underlying pathophysiological and clinical findings, on the mechanism of action, and on its potential side effects.
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Affiliation(s)
- M S Pergolini
- Department of Medical Clinics and Therapy, I Faculty of Medicine and Surgery, University Sapienza, Rome, Italy.
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43
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Polak BCP, Meenken CI, Smulders YM. [Visual loss as a sign of hypertension]. Ned Tijdschr Geneeskd 2009; 153:A379. [PMID: 20003563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 26-year-old male patient had been suffering from a decreased visual acuity in both eyes for 3 weeks. This appeared to be due to malignant hypertension. The hypertension went unnoticed until papillary and macular oedema were detected during fundoscopy. Hypertension can develop at all ages and may give rise to visual complaints or even to loss of vision. Insufficient clinical awareness of the atypical manifestations of severe hypertension and of the differential diagnosis of loss of vision may lead to irreversible damage of organs, in this patient the left eye. Fundoscopy is sometimes indicated in patients with severe hypertension to assess damage to the eye and to decide whether the patient must be hospitalised.
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Ziemer C. [Nitrospray in hypertensive crisis with acute nosebleed. Suddenly the patient collapsed]. MMW Fortschr Med 2008; 150:7. [PMID: 18557212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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45
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Ardigo S, Rutschmann O, Waeber B, Pechère-Bertschi A. [How urgent is it to decrease high blood pressure?]. Praxis (Bern 1994) 2008; 97:431-436. [PMID: 18551913 DOI: 10.1024/1661-8157.97.8.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Severe hypertension represents a frequent problem for the general practitioner. One has to decide if the blood pressure needs to be decreased immediately (hypertensive emergency), or if the blood pressure maybe progressively decreased in a few hours and normalized in a few days (hypertensive crisis). Thus it is crucial to identify on the basis of the clinical history and a careful physical examination, the patients for whom the arterial blood pressure elevation represents an acute danger for organ damage or a vital threat in the absence of immediate blood pressure control. In the case of hypertensive crisis, oral medication is usually sufficient (slow release or GITS nifedipine, nitroglycerin, labetalol, captopril). The hypertensive emergency sometimes requires an oral medication before the admission to the emergency room, then followed by intravenous drug administration (sodium nitroprussiate, nitroglycerin, labetalol).
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Affiliation(s)
- S Ardigo
- Service de Diabétologie-Endocrinologie et Nutrition, Département Rehabilitation et Gériatrie, HUG, Geneve
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Chiotoroiu S, Stefaniu I. [Malignant hypertension--case report]. Oftalmologia 2008; 52:84-88. [PMID: 19065921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors present the case of a 25 year old man who presented in our clinic because of an important decreasing of his visual acuity at AO (OS > OD) which had installed progressively 3 months before his presentation. After the FAO examination there were found important changes with the bilateral presence of the papilledema, macular edema, hemorrhages in flame on the route of big vessels and the presence of multiple hard and soft exudates. After the clinical examination, it was found the presence of arterial hypertension TA = 240/140. The investigations from the laboratory pointed out important changes of the values of urea and creatinine, values which are characteristic for advanced stages of IR. After setting up the hypertensive treatment and the tension re-balancing it was found a slightly improvement of the ocular symptomatology, the patient prognosis remains reserved because of advanced renal lesions. The purpose of this case presentation is to make sensible doctors in general and eye doctors in particular about the importance of general clinical examination in establishing the final diagnosis. We mention that before presenting in our clinic, the patient did various ophthalmologic checking and complementary investigations suspecting a retinal vasculitis.
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Affiliation(s)
- Silvia Chiotoroiu
- Clinica de Oftalmologie, Spitalul Clinic de Urgenţă Militar Central Bucureşti
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48
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Zarina AL, Hamidah A, Zulkifli SZ, Zulfiqar MA, Jamal R. Malignant pancreatic carcinoid tumour. Singapore Med J 2007; 48:e320-e322. [PMID: 18043827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pancreatic carcinoid tumours are rare, particularly within the paediatric population. The clinical presentation is largely dependent on the functionality of the tumour. Although the tumour is generally slow-growing, surgical resection is still the mainstay of curative treatment. Morbidity is, however, significantly contributed by secretion of excess hormones; in view of this, biotherapy is an important treatment strategy. Octreotide, a somatostatin analogue, has been shown to be successful in both symptomatic control and stability of tumour progression. We report a 12-year-old girl, who presented with hypertensive crisis, and showed good response to a combination of chemotherapy and octreotide.
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Affiliation(s)
- A L Zarina
- Paediatric Haematology & Oncology Unit, Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras 56000, Kuala Lumpur, Malaysia.
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Schuster F, Metterlein T, Negele S, Gardill A, Schwemmer U, Roewer N, Anetseder M. Intramuscular injection of sevoflurane detects malignant hyperthermia predisposition in susceptible pigs. Anesthesiology 2007; 107:616-20. [PMID: 17893458 DOI: 10.1097/01.anes.0000281915.85577.1a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors hypothesized that intramuscular sevoflurane injection allows diagnostic differentiation between malignant hyperthermia-susceptible (MHS) and -nonsusceptible (MHN) pigs by measurement of intramuscular lactate and carbon dioxide partial pressure (PCO2), and that dantrolene reduces the sevoflurane-induced PCO2 increase. METHODS With approval of the local animal care committee, microdialysis probes with attached microtubing for sevoflurane injection were placed in the adductor muscles of nine MHS and six MHN pigs, and PCO2 probes with microtubing were positioned in the triceps muscle of eight MHS and six MHN pigs. After equilibration, sevoflurane boluses at different concentrations and a sevoflurane-dantrolene bolus were injected synchronously. Lactate, pyruvate, and glucose as well as PCO2 were measured spectrophotometrically, and the rate of PCO2 increase was calculated. RESULTS Intramuscular sevoflurane injection increased local lactate and PCO2 dose dependently, and significantly higher in MHS than in MHN pigs. Measurement of the rate of PCO2 increase allowed a distinct differentiation between single MHS and MHN pigs. No significant increase in PCO2 was found with sevoflurane and dantrolene. CONCLUSIONS Local sevoflurane induces a hypermetabolic reaction measured by PCO2 and lactate increases. The reduced PCO2 increase in MHS after sevoflurane and dantrolene injection is likely to be a result of the sevoflurane-mediated calcium release and its antagonism by dantrolene. Sevoflurane may be useful for a less invasive diagnostic test for malignant hyperthermia in humans.
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Affiliation(s)
- Frank Schuster
- Department of Anesthesiology, University of Würzburg, Germany.
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Schoenenberger AW, Erne P, Ammann S, Perrig M, Bürgi U, Stuck AE. Prediction of hypertensive crisis based on average, variability and approximate entropy of 24-h ambulatory blood pressure monitoring. J Hum Hypertens 2007; 22:32-7. [PMID: 17625588 DOI: 10.1038/sj.jhh.1002263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P<0.01), average of systolic BP (P=0.02) and average of diastolic BP (P=0.03) were significant predictors of hypertensive crisis. The incidence rate ratio of hypertensive crisis was 14.0 (95% confidence interval (CI) 1.8, 631.5; P<0.01) for high ApEn of systolic BP as compared to low values. In multivariable regression analysis, ApEn of systolic (P=0.01) and average of diastolic BP (P<0.01) were independent predictors of hypertensive crisis. A combination of these two measures had a positive predictive value of 75%, and a negative predictive value of 91%, respectively. ApEn, combined with other measures of 24-h ABPM, is a potentially powerful predictor of hypertensive crisis. If confirmed in independent samples, these findings have major clinical implications since measures predicting the risk of hypertensive crisis define patients requiring intensive follow-up and intensified therapy.
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Affiliation(s)
- A W Schoenenberger
- University Department of Geriatrics, Spital Netz Bern Ziegler and University of Bern, Bern, Switzerland.
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