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Shen F, Jiang G, Philips S, Cantor E, Gardner L, Xue G, Cunningham G, Kassem N, O'Neill A, Cameron D, Suter TM, Miller KD, Sledge GW, Schneider BP. Germline predictors for bevacizumab induced hypertensive crisis in ECOG-ACRIN 5103 and BEATRICE. Br J Cancer 2024; 130:1348-1355. [PMID: 38347093 PMCID: PMC11014938 DOI: 10.1038/s41416-024-02602-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Bevacizumab is a beneficial therapy in several advanced cancer types. Predictive biomarkers to better understand which patients are destined to benefit or experience toxicity are needed. Associations between bevacizumab induced hypertension and survival have been reported but with conflicting conclusions. METHODS We performed post-hoc analyses to evaluate the association in 3124 patients from two phase III adjuvant breast cancer trials, E5103 and BEATRICE. Differences in invasive disease-free survival (IDFS) and overall survival (OS) between patients with hypertension and those without were compared. Hypertension was defined as systolic blood pressure (SBP) ≥ 160 mmHg (n = 346) and SBP ≥ 180 mmHg (hypertensive crisis) (n = 69). Genomic analyses were performed to evaluate germline genetic predictors for the hypertensive crisis. RESULTS Hypertensive crisis was significantly associated with superior IDFS (p = 0.015) and OS (p = 0.042), but only IDFS (p = 0.029; HR = 0.28) remained significant after correction for prognostic factors. SBP ≥ 160 mmHg was not associated with either IDFS or OS. A common single-nucleotide polymorphism, rs6486785, was significantly associated with hypertensive crisis (p = 8.4 × 10-9; OR = 5.2). CONCLUSION Bevacizumab-induced hypertensive crisis is associated with superior outcomes and rs6486785 predicted an increased risk of this key toxicity.
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Affiliation(s)
- Fei Shen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Guanglong Jiang
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Santosh Philips
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erica Cantor
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura Gardner
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gloria Xue
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Nawal Kassem
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anne O'Neill
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Thomas M Suter
- Swiss Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Kathy D Miller
- Indiana University School of Medicine, Indianapolis, IN, USA
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2
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Lagman-Bartolome AM, Im J, Gladstone J. Headaches Attributed to Disorders of Homeostasis. Neurol Clin 2024; 42:521-542. [PMID: 38575264 DOI: 10.1016/j.ncl.2023.12.007] [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: 04/06/2024]
Abstract
Headaches attributed to disorders of homeostasis include those different headache types associated with metabolic and systemic diseases. These are headache disorders occurring in temporal relation to a disorder of homeostasis including hypoxia, high altitude, airplane travel, diving, sleep apnea, dialysis, autonomic dysreflexia, hypothyroidism, fasting, cardiac cephalalgia, hypertension and other hypertensive disorders like pheochromocytoma, hypertensive crisis, and encephalopathy, as well as preeclampsia or eclampsia. The proposed mechanism behind the causation of these headache subtypes including diagnostic criteria, evaluation, treatment, and overall management will be discussed.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, Schulich School of Medicine & Dentistry, University of Western Ontario, 800 Commissioner's Road East, London, Ontario N6A5W9, Canada.
| | - James Im
- Department of Medicine, Division of Adult Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B1W8, Canada
| | - Jonathan Gladstone
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Gladstone Headache Clinic, 1333 Sheppard Avenue E, Suite 122, North York, Ontario M2J1V1, Canada
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3
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Rubio González E, de Valdenebro Recio M, Galán Fernández MI. [Hypertensive Emergency as the Debut of Paraneoplastic Cushing Syndrome]. Hipertens Riesgo Vasc 2024; 41:135-138. [PMID: 38508875 DOI: 10.1016/j.hipert.2023.10.003] [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: 10/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 03/22/2024]
Abstract
We present the case of a patient with a history of renal-vascular hypertension treated with stent one year previously, who attended the emergency room due to hypertensive emergency and dyspnea. Once the first suspicion of renal artery restenosis was ruled out with CT angiography, the study was completed, confirming the diagnosis of lung cancer through imaging and pathological anatomy. In the hormonal study, elevation of ACTH, hypercortisolism and analytical data of hyperaldosteronism were detected. With the final diagnosis of Cushing's syndrome secondary to ectopic production of ACTH, medical treatment was started, without being able to receive anything else due to the death of the patient after a few days.
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Affiliation(s)
- E Rubio González
- Universidad de Puerta de Hierro, Hospital de Majadahonda, Madrid, España.
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4
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Alexander MR, Aday AW, Lewis J, Deyholos CJ, Luther JM. Flow Disturbances: Competing Interests in a Case of Hypertensive Emergency. Hypertension 2024; 81:676-681. [PMID: 38507508 DOI: 10.1161/hypertensionaha.124.22107] [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: 03/22/2024]
Affiliation(s)
- Matthew R Alexander
- Department of Medicine, Division of Clinical Pharmacology (M.R.A.), Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center (M.R.A., A.W.A.), Vanderbilt University Medical Center, Nashville, TN
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN (M.R.A.)
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN (M.R.A.)
| | - Aaron W Aday
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center (M.R.A., A.W.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Julia Lewis
- Department of Medicine, Division of Nephrology and Hypertension (J.L., J.M.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Christine J Deyholos
- Department of Vascular Surgery (C.J.D.), Vanderbilt University Medical Center, Nashville, TN
| | - James M Luther
- Department of Medicine, Division of Nephrology and Hypertension (J.L., J.M.L.), Vanderbilt University Medical Center, Nashville, TN
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5
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Robles NR, Fici F, Grassi G. Management of hypertensive urgencies: a new opportunity for unattended blood pressure measurement. J Hum Hypertens 2024; 38:295-297. [PMID: 38514866 DOI: 10.1038/s41371-024-00907-4] [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] [Received: 11/08/2023] [Revised: 03/02/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Affiliation(s)
| | - Francesco Fici
- Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain
| | - Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Milan, Italy
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6
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Arendash JM, Chiu C, Wang J, Mihm F. Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report. J Med Case Rep 2024; 18:161. [PMID: 38500192 PMCID: PMC10949556 DOI: 10.1186/s13256-024-04497-0] [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] [Received: 10/16/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma resulting in hypertensive urgency. CASE PRESENTATION A 69-year-old white male patient with a previously diagnosed pheochromocytoma presented to the emergency department with nausea and vomiting and was found to have hypertensive urgency. Computed tomography scan did not show any acute abdominal pathology and history was inconsistent with a gastrointestinal etiology. Patient had a history of daily cannabinoid use for many years and repeated self-limited hyperemesis episodes, and thus a diagnosis of cannabinoid-induced hyperemesis syndrome was made. It was concluded that the likely explanation for the hypertensive urgency was from physical compression of his adrenal tumor during the episodes of retching resulting in a catecholamine surge. The patient was given antiemetics and admitted to the intensive care unit for blood pressure management. Blood pressure was initially controlled with phentolamine and a clevidipine infusion, then transitioned to oral doxazosin and phenoxybenzamine. Hyperemesis and abdominal pain resolved after 24 hours, and his blood pressure returned to baseline. The patient was discharged with the recommendation to stop all cannabis use. On follow-up, his blood pressure remained well controlled, and he subsequently underwent adrenalectomy for tumor removal. CONCLUSION Hyperemesis can cause hypertensive events in patients with pheochromocytoma by increasing abdominal pressure, leading to catecholamine release.
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Affiliation(s)
- Jeffrey M Arendash
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA.
| | - Cornel Chiu
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - Jocelyn Wang
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - Fred Mihm
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
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7
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Manolis AJ, Kallistratos MS, Koutsaki M, Doumas M, Poulimenos LE, Parissis J, Polyzogopoulou E, Pittaras A, Muiesan ML, Mancia G. The diagnostic approach and management of hypertension in the emergency department. Eur J Intern Med 2024; 121:17-24. [PMID: 38087668 DOI: 10.1016/j.ejim.2023.11.028] [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: 01/26/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 03/08/2024]
Abstract
Hypertension urgency and emergency represents a challenging condition in which clinicians should determine the assessment and/or treatment of these patients. Whether the elevation of blood pressure (BP) levels is temporary, in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. Unfortunately, current guidelines provide few recommendations concerning the diagnostic approach and treatment of emergency department patients presenting with severe hypertension. Target organ damage determines: the timeframe in which BP should be lowered, target BP levels as well as the drug of choice to use. It's important to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment.
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Affiliation(s)
- A J Manolis
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece
| | - M S Kallistratos
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece.
| | - M Koutsaki
- Asklepeion General Hospital, Cardiology Department, Vasileos Pavlou 1 street, Voula Greece
| | - M Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - L E Poulimenos
- Asklepeion General Hospital, Cardiology Department, Vasileos Pavlou 1 street, Voula Greece
| | - J Parissis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - E Polyzogopoulou
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - A Pittaras
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia & 2a Medicina ASST Spedali Civili di Brescia, 25121 Brescia, Italy
| | - G Mancia
- University of Milano-Bicocca (Emeritus Professor), Milan, Italy
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8
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Eurick-Bering K, Todd B, Cameron-Comasco L. Slow on the Draw-ED Management of Elevated BP in Older Adults. Curr Hypertens Rep 2024; 26:107-117. [PMID: 37987967 DOI: 10.1007/s11906-023-01284-y] [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] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE OF REVIEW The purpose of this study is to review data surrounding the emergency department management of elevated blood pressure in older adults, including the management of hypertensive crisis and outpatient management of markedly elevated blood pressure. RECENT FINDINGS Acute lowering of blood pressure in older adults with markedly elevated blood pressure may lead to serious complications without improvements in hospital length of stay, return visits, or mortality. Older adults presenting with elevated blood pressures without evidence of end-organ damage should be referred for outpatient management of their blood pressure. Treatment of hypertensive emergency should follow standard guidelines with additional considerations for aging physiology. Acute lowering of elevated blood pressure in older adults without evidence of end-organ damage has the potential for harm. If the emergency physician opts to acutely treat, they should consider the increased risk of side effects in older adults and avoid Beers list medications including short-acting nifedipine and clonidine.
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Affiliation(s)
- Kianna Eurick-Bering
- Department of Emergency Medicine, William Beaumont University Hospital, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Brett Todd
- Department of Emergency Medicine, William Beaumont University Hospital, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren Cameron-Comasco
- Department of Emergency Medicine, William Beaumont University Hospital, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA.
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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9
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Sole Cruz E, Stolowy N, Attia R, Audoin B, Demortière S. Acute posterior ischemic optic neuropathy associated with a hypertensive crisis. Rev Neurol (Paris) 2024; 180:218-219. [PMID: 38135628 DOI: 10.1016/j.neurol.2023.12.002] [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: 11/08/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Affiliation(s)
- E Sole Cruz
- Department of Neurology, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - N Stolowy
- Department of Ophtalmology, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - R Attia
- Department of Ophtalmology, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - B Audoin
- Department of Neurology, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France; CNRS, CRMBM, Aix-Marseille University, Marseille, France
| | - S Demortière
- Department of Neurology, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.
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10
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Awad L, Sethuraman U. Evaluation and Management of Elevated BP in Children in the ED. Curr Hypertens Rep 2024; 26:99-105. [PMID: 37975974 DOI: 10.1007/s11906-023-01283-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] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW Pediatric hypertension has been on the rise over the past four decades. While most cases are evaluated and managed in the primary healthcare setting, some children may be referred to the emergency department (ED) for an expedited workup of elevated blood pressure or for management of hypertensive crisis. RECENT FINDINGS Acute severe hypertension without end-organ damage and hypertensive emergency are life-threatening conditions that healthcare providers must be prepared to accurately recognize and treat as pediatric hypertension increases in prevalence. In this article, we review the most recent definitions of elevated blood pressure and hypertension and discuss the updated literature on the evaluation and management of hypertension and hypertensive crisis of children in the ED.
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Affiliation(s)
- Lilian Awad
- Children's Hospital of Michigan, Detroit, MI, USA.
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11
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Ma H, Wang C, Jiang M, Jin K, Xu T, Wang Z, Xu J, Ni L, Shi H, Shen P, Chen Y, Feng X, Zhang W. Persistently elevated sFlt-1 and recovery of reduced ADAMTS13 activity in malignant hypertension. J Hypertens 2024; 42:410-419. [PMID: 37889602 DOI: 10.1097/hjh.0000000000003601] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Malignant hypertension (MHT) characterized by acute hypertension with retinopathy or multiorgan damage, is a severe form of hypertensive emergency and associated with target organ involvement and poor kidney outcome. However, the underlying mechanisms are unclear. METHODS Eighty-four patients with acute severe hypertension from the Nephrology Department and Emergency Department in a single center during January 2016 and December 2017 were prospectively enrolled and divided into MHT ( n = 48) and non-MHT ( n = 36) subgroups according to target organ evaluation. Forty healthy controls were recruited. Serum soluble Fms-like tyrosine kinase-1 (sFlt-1) levels and plasma ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) activity were examined at baseline and 12-month follow-up. Renal endpoints were defined as a significant decrease in the estimated glomerular filtration rate (eGFR) of more than 40% or the occurrence of end-stage renal disease. RESULTS Serum sFlt-1 levels were persistently elevated in MHT. Baseline serum sFLT-1 levels were correlated with plasma ADAMTS13 activity and markers of target organ damage. Plasma ADAMTS13 activity was reduced in both MHT and non-MHT patients and recovered to the normal range at 12-month follow-up. During an average follow-up time of 53 ± 13 months, the restoration of reduced ADAMTS13 activity was correlated with the improvement of kidney function and independently reduced the risk of renal endpoints. CONCLUSIONS Abnormal angiogenesis and endothelial damage are involved in the pathophysiology of hypertensive emergency. Evaluation of ADAMTS13 and sFlt-1 may help in the diagnosis and assessment of MHT. Recovery of ADAMTS13 predicts better renal outcome in patients with hypertensive emergencies.
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Affiliation(s)
- Hongkun Ma
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Chongjian Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Mengdi Jiang
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kexin Jin
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Tingting Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhiyu Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jing Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Liyan Ni
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Hao Shi
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Pingyan Shen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Yongxi Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Xiaobei Feng
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Wen Zhang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
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12
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Calderon-Ocon V, Cueva-Peredo F, Bernabe-Ortiz A. Prevalence, trends, and factors associated with hypertensive crisis among Peruvian adults. CAD SAUDE PUBLICA 2024; 40:e00155123. [PMID: 38381865 PMCID: PMC10877693 DOI: 10.1590/0102-311xen155123] [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: 08/16/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 02/23/2024] Open
Abstract
There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis.
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13
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Yonezawa Y, Koga K, Higashi Y, Hasebe M, Fukushima C, Omiya C, Nishioka K, Yahata K. A Successfully Treated Case of Posterior Ischemic Optic Neuropathy That Developed during Antihypertensive Therapy for Hypertensive Emergency. Intern Med 2024; 63:527-532. [PMID: 37344439 PMCID: PMC10937120 DOI: 10.2169/internalmedicine.1550-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/12/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
A 33-year-old woman developed hypertensive emergency (268/168 mmHg) with renal failure and hypertensive retinopathy. Four hours after the initiation of antihypertensive therapy with the continuous infusion of nicardipine, her blood pressure (BP) decreased to 168/84 mmHg; however, the patient developed blindness. She was diagnosed with posterior ischemic optic neuropathy (PION). Her BP was maintained at approximately 175/90 mmHg until her vision improved. Olmesartan was initiated on day 13, and her BP decreased to approximately 135/95 mmHg without the re-exacerbation of vision loss. Although the prognosis of PION is poor, its early diagnosis and gradual antihypertensive therapy may help preserve the patient's vision.
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Affiliation(s)
- Yuta Yonezawa
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | - Kenichi Koga
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | | | - Masako Hasebe
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | | | - Chiaki Omiya
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | | | - Kensei Yahata
- Department of Nephrology, Osaka Red Cross Hospital, Japan
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14
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Fragoulis C, Polyzos D, Mavroudis A, Tsioufis PA, Kasiakogias A, Leontsinis I, Mantzouranis E, Kalos T, Sakalidis A, Ntalakouras J, Andrikou I, Dimitriadis K, Konstantinidis D, Thomopoulos C, Tsioufis K. One-year outcomes following a hypertensive urgency or emergency. Eur J Intern Med 2024; 120:107-113. [PMID: 37872037 DOI: 10.1016/j.ejim.2023.10.020] [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: 06/16/2023] [Revised: 09/06/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
There are scarce data on the comparative prognosis between patients with hypertensive emergencies (HE), urgencies (HU), and those without HU or HE (HP). Our study aimed to compare cardiovascular (CV) outcomes of HE, HU, and HP during a 12-month follow-up period. The population consisted of 353 consecutive patients presenting with HE or HU in a third-care emergency department and subsequently referred to our hypertension center for follow-up. After both groups completed scheduled follow-up visits, patients with HU were matched one-to-one by age, sex, and hypertension history with HP who attended our hypertension center during the same period. Primary outcomes were 1) a recurrent hypertensive HU or HE event and 2) non-fatal CV events (coronary heart disease, stroke, heart failure, or CV interventions), while secondary outcomes were 1) all-cause death, 2) CV death, 3) non-CV death, and 4) any-cause hospitalization. Events were prospectively registered for all three groups. During the study period, 81 patients were excluded for not completing follow-up. Among eligible patients(HE = 94; HU = 178), a total of 90 hospitalizations and 14 deaths were recorded; HE registered greater CV morbidity when compared with HU (29 vs. 9, HR 3.43, 95 % CI 1.7-6.9, p = 0.001), and increased CV mortality (8 vs. 1, HR 13.2, 95 % CI 1.57-110.8, p = 0.017). When opposing HU to HP, events did not differ substantially. Cox regression models were adjusted for age, sex, CV and chronic kidney disease, diabetes mellitus, and smoking. During 1-year follow-up, the prognosis of HU was better than HE but not different compared to HP. These results highlight the need for improved care of HU and HE.
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Affiliation(s)
- Christos Fragoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitrios Polyzos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Andreas Mavroudis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Panagiotis-Anastasios Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Emmanouil Mantzouranis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Theodoros Kalos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Athanasios Sakalidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - John Ntalakouras
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Andrikou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitris Konstantinidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Costas Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, 2 Helena Venizelou Street, 11521 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece.
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15
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Araujo-Castro M, García Sanz I, Mínguez Ojeda C, Hanzu F, Mora M, Vicente A, Blanco Carrera C, Miguel Novoa PD, López García MDC, Lamas C, Manjón-Miguélez L, Del Castillo Tous M, Rodríguez de Vera P, Barahona San Millán R, Recasens M, Fernández-Ladreda MT, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Álvarez Escolá C, García Centeno R, Calatayud M. Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas. J Hypertens 2024; 42:252-259. [PMID: 37851004 DOI: 10.1097/hjh.0000000000003596] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE To identify presurgical and surgical risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas (PGLs) (PPGLs). METHODS Retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. Intraoperative hypertensive crisis was defined as systolic blood pressure (SBP) greater than 200 mmHg lasting more than 1 min and postoperative hypertensive crisis as SBP greater than 180 mmHg or diastolic blood pressure (DBP) greater than 110 mmHg. RESULTS A total of 296 surgeries were included. Alpha presurgical blockade was employed in 93.2% of the cases and beta-adrenergic in 53.4%. Hypertensive crisis occurred in 20.3% ( n = 60) of the surgeries: intraoperative crisis in 56 and postoperative crisis in 6 cases (2 cases had both types of crises). We identified as risk factors of intraoperative hypertensive crisis, absence of presurgical glucocorticoid therapy (odds ratio [OR] 3.48; 95% confidence interval [CI] 1.19-10.12) higher presurgical SBP (OR 1.22 per each 10 mmHg, 95% CI 1.03-1.45), a larger tumor size (OR 1.09 per each 10 mm, 95% CI 1.00-1.19) and absence of oral sodium repletion (OR 2.59, 95% CI 1.25-5.35). Patients with hypertensive crisis had a higher rate of intraoperative bleeding ( P < 0.001), of intraoperative hemodynamic instability ( P < 0.001) and of intraoperative hypotensive episodes ( P < 0.001) than those without hypertensive crisis. CONCLUSION Intraoperative hypertensive crisis occurs in up to 20% of the PPGL resections. Patients not pretreated with glucocorticoid therapy before surgery, with larger tumors and higher presurgical SBP and who do not receive oral sodium repletion have a higher risk for developing hypertensive crisis during and after PPGL surgery.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid
- University of Alcalá
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa
| | | | - Felicia Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona
| | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona
| | - Almudena Vicente
- Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo
| | | | | | | | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, Albacete
| | - Laura Manjón-Miguélez
- Endocrinology & Nutrition Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias. Oviedo
| | | | | | | | - Mónica Recasens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona
| | | | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario de Cabueñes, Asturias
| | | | | | | | | | | | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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16
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Carvalho PR, Gonçalves F, Magalhães P, Moreira JI. Hypertensive emergency secondary to atropine. Hipertens Riesgo Vasc 2024; 41:58-61. [PMID: 38403566 DOI: 10.1016/j.hipert.2023.08.003] [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: 08/08/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 02/27/2024]
Abstract
Atropine, a competitive antagonist of acetylcholine muscarinic receptors, is commonly used to treat severe bradycardia by blocking parasympathetic activity. We present a rare case of hypertensive emergency following atropine administration, with only one previous report in the literature. A 78-year-old woman with essential hypertension and hypercholesterolemia was admitted to the cardiac intensive care unit for non-ST segment elevation myocardial infarction. During coronary angiography, an occlusion of the right coronary artery was identified. While removing the diagnostic catheter through the right radial artery, the patient experienced intense pain and discomfort, accompanied by a vasovagal reflex characterized by bradycardia and hypotension. Intravenous atropine (0.5mg) was administered, leading to a rapid rise in heart rate with frequent ventricular ectopy. Subsequently, a progressive and exaggerated elevation in arterial blood pressure occurred, peaking at 294/121mmHg approximately 10min after atropine administration. The patient developed hypertensive acute pulmonary edema, successfully treated with intravenous nitroglycerine (10mg) and furosemide (60mg). Blood pressure normalized after approximately 14min. The exact mechanism of atropine-induced hypertensive emergency remains unknown. While hypertensive emergencies with atropine are exceedingly rare, healthcare professionals should be aware of this potential effect and be prepared for prompt intervention.
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Affiliation(s)
- P R Carvalho
- Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Hospital of Vila Real, Vila Real, Portugal.
| | - F Gonçalves
- Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Hospital of Vila Real, Vila Real, Portugal
| | - P Magalhães
- Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Hospital of Vila Real, Vila Real, Portugal
| | - J I Moreira
- Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Hospital of Vila Real, Vila Real, Portugal
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17
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Talle MA, Doubell AF, Robbertse PPS, Lahri S, Herbst PG. Clinical Profile of Patients with Hypertensive Emergency Referred to a Tertiary Hospital in the Western Cape Province of South Africa. Curr Hypertens Rev 2023; 19:194-205. [PMID: 37957866 DOI: 10.2174/0115734021266958231101094556] [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: 07/06/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Despite advances in managing hypertension, hypertensive emergencies remain a common indication for emergency room visits. Our study aimed to determine the clinical profile of patients referred with hypertensive emergencies. METHODS We conducted an observational study involving patients aged ≥18 years referred with hypertensive crisis. A diagnosis of hypertensive emergencies was based on a systolic blood pressure (BP) ≥180 mmHg and/or a diastolic BP ≥110 mmHg, with acute hypertension-mediated organ damage (aHMOD). Patients without evidence of aHMOD were considered hypertensive urgencies. Hypertensive disorders of pregnancy and unconscious patients were excluded from the study. RESULTS Eighty-two patients were included, comprising 66 (80.5%) with hypertensive emergencies and 16 (19.5%) with hypertensive urgencies. The mean age of patients with hypertensive emergencies was 47.9 (13.2) years, and 66.7% were males. Age, systolic BP, and duration of hypertension were similar in the hypertensive crisis cohort. Most patients with hypertensive emergencies reported nonadherence to medication (78%) or presented de novo without a prior diagnosis of hypertension (36%). Cardiac aHMOD (acute pulmonary edema and myocardial infarction) occurred in 66%, while neurological emergencies (intracranial hemorrhage, ischemic stroke, and hypertensive encephalopathy) occurred in 33.3%. Lactate dehydrogenase (LDH) (P < 0.001), NT-proBNP (P=0.024), and cardiac troponin (P<0.001) were higher in hypertensive emergencies compared to urgencies. LDH did not differ in the subtypes of hypertensive emergencies. CONCLUSION Cardiovascular and neurological emergencies are the most common hypertensive emergencies. Most patients reported nonadherence to medication or presented de novo without a prior diagnosis of hypertension.
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Affiliation(s)
- Mohammed A Talle
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Health Sciences Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri and University of Maiduguri Teaching Hospital, Maiduguri 600004, Nigeria
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Health Sciences Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
| | - Pieter-Paul S Robbertse
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Health Sciences Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
| | - Philip G Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Health Sciences Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
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