Anna Astarita1, Michele Covella2, Fabrizio Vallelonga1, Marco Cesareo1, Silvia Totaro3, Luca Ventre4, Franco Aprà5, Franco Veglio1, Alberto Milan1. 1. Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin. 2. Emergency Department, U.Parini Hospital, Aosta. 3. Emergency Division, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin. 4. Ophthalmology Division, 'Città della Salute e della Scienza' University Hospital, Turin. 5. High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy.
Abstract
OBJECTIVES: The prevalence of hypertensive emergencies and urgencies and of acute hypertension-mediated organ damage (aHMOD) in emergency departments is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of hypertensive emergencies and hypertensive urgencies in emergency departments and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD. METHODS: We conducted a systematic literature search on PubMed, OVID, and Web of Science from their inception to 22 August 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis. RESULTS: Eight studies were analysed, including 1970 hypertensive emergencies and 4983 hypertensive urgencies. The prevalence of hypertensive emergencies and hypertensive urgencies was 0.3 and 0.9%, respectively [odds ratio for hypertensive urgencies vs. hypertensive emergencies 2.5 (1.4-4.3)]. Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorrhagic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. Hypertensive urgency patients were younger than hypertensive emergency patients by 5.4 years and more often complained of nonspecific symptoms and/or headache, whereas specific symptoms were more frequent among hypertensive emergency patients. CONCLUSION: Hypertensive emergencies and hypertensive urgencies are a frequent cause of access to emergency departments, with hypertensive urgencies being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.
OBJECTIVES: The prevalence of hypertensive emergencies and urgencies and of acute hypertension-mediated organ damage (aHMOD) in emergency departments is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of hypertensive emergencies and hypertensive urgencies in emergency departments and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD. METHODS: We conducted a systematic literature search on PubMed, OVID, and Web of Science from their inception to 22 August 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis. RESULTS: Eight studies were analysed, including 1970 hypertensive emergencies and 4983 hypertensive urgencies. The prevalence of hypertensive emergencies and hypertensive urgencies was 0.3 and 0.9%, respectively [odds ratio for hypertensive urgencies vs. hypertensive emergencies 2.5 (1.4-4.3)]. Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorrhagic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. Hypertensive urgency patients were younger than hypertensive emergency patients by 5.4 years and more often complained of nonspecific symptoms and/or headache, whereas specific symptoms were more frequent among hypertensive emergency patients. CONCLUSION:Hypertensive emergencies and hypertensive urgencies are a frequent cause of access to emergency departments, with hypertensive urgencies being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.
Authors: Jonathan Hanna; Lama Ghazi; Yu Yamamoto; Michael Simonov; Tayyab Shah; Francis P Wilson; Aldo J Peixoto Journal: Am J Hypertens Date: 2022-05-10 Impact factor: 3.080
Authors: Fabrizio Vallelonga; Marco Cesareo; Leonardo Menon; Lorenzo Airale; Dario Leone; Anna Astarita; Giulia Mingrone; Maria Tizzani; Enrico Lupia; Franco Veglio; Alberto Milan Journal: Front Cardiovasc Med Date: 2022-05-16
Authors: Ioannis Leontsinis; Vasilios Papademetriou; Christina Chrysohoou; Maria Kariori; Ioannis Dalakouras; Panayotis Tolis; Christos Fragoulis; Theodoros Kalos; Fotios-Panagiotis Tatakis; Kyriakos Dimitriadis; Michael Doumas; Helen Sambatakou; Maria Pirounaki; Constantinos Mihas; Niki Katsiki; Sonu Bhaskar; Georgios Tsivgoulis; Dimitrios Tousoulis; Maciej Banach; Konstantinos Tsioufis Journal: Arch Med Sci Date: 2021-09-23 Impact factor: 3.707
Authors: Karl G Reis; Raymond Wilson; Fredrick Kalokola; Bahati Wajanga; Myung-Hee Lee; Monika Safford; Robert N Peck Journal: Am J Hypertens Date: 2020-12-31 Impact factor: 3.080