Definitions and Epidemiological Aspects of Hypertensive Urgencies and Emergencies
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Definitions and Epidemiological Aspects of Hypertensive Urgencies and Emergencies Anna Paini1,2 · Carlo Aggiusti1,2 · Fabio Bertacchini1,2 · Claudia Agabiti Rosei1,2 · Giulia Maruelli1,2 · Chiara Arnoldi1,2 · Sara Cappellini1,2 · Maria Lorenza Muiesan1,2 · Massimo Salvetti1,2 Received: 19 March 2018 / Accepted: 6 June 2018 © Springer International Publishing AG, part of Springer Nature 2018
Abstract Acute blood pressure (BP) elevation represents a frequent reason of concern for clinicians in everyday clinical practice. The terms “hypertensive emergencies” and “hypertensive urgencies” may be used in order to better define the so called “hypertensive crises”. A hypertensive emergency may be defined as a condition characterized by an acute and severe elevation of blood pressure (BP) associated to a new onset or worsening organ damage (OD). A hypertensive urgency may be defined as a condition characterized by an isolated elevation of BP values without evidence of acute hypertensive OD. This article will review the definition, the prevalence, and the prognostic implications of hypertensive emergencies and urgencies. Keywords Hypertension emergencies · Hypertension urgencies · Definition · Epidemiology
1 Introduction Management of acute blood pressure (BP) elevation is not uncommon in everyday clinical practice, and may represent a concern for general practitioners and specialists. Appropriate management of acute BP elevation is crucial in order to prevent severe organ damage but also in order to avoid unnecessary hospitalizations. Current hypertension Guidelines have suggested to replace the term “hypertensive crisis” with ‘hypertensive emergencies’ or ‘hypertensive urgencies’. Both the European Society of Hypertension [1] and the American Society of Hypertension [2] have defined a ‘hypertensive emergency’ as a condition characterized by an acute and severe elevation of BP associated to a new onset or worsening organ damage (OD) (Fig. 1). Severe BP elevation associated with hypertensive encephalopathy, acute stroke, intracranial hemorrhage, acute coronary This article is part of the topical collection on Hypertension Urgencies & Emergencies. * Massimo Salvetti [email protected] 1
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
C/O 2ª Medicina ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
2
syndromes, pulmonary edema, but also aortic dissection, acute or rapidly progressing renal failure, sympathetic crises (i.e. cocaine toxicity/pheochromocytoma), eclampsia or severe pre-eclampsia all represent hypertensive emergencies, i.e. conditions in which the elevation of BP values may contribute to the development and/or worsening of organ damage [1–3]. ‘Malignant hypertension’ may be considered a hypertensive emergency which involves the retinal vasculature (bilateral retinal hemorrhages and exudates, with or without papilledema) and the kidney (renal failure). It is a rare condition (less than 1% of hypertensives), ch
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