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| The pathophysiology of hypertensive crisis. 

| The pathophysiology of hypertensive crisis. 

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Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-spe...

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... second mechanism is the activation of renin-angiotensin system, leading to further vasoconstriction and thus generating a vicious cycle of continuous injury and subsequently ischemia (2). Besides these mechanisms, a prothrombotic state may play a key role in hypertensive crisis; a recent, albeit small, study showed that sP-selectin was significantly higher in patients with hypertensive crisis compared with normotensive controls regardless of the presence of retinopathy, which suggests that platelet activation is a relatively early finding in the pathophysiologic sequelae of hypertensive crisis (11) (Figure 1). ...

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... Hypertension (HT) is a common disease in the world, it is reported that about 25% of the population have been suffered from this serious illness, and the incidence rate increases with age (Chockalingam et al. 2006). Moreover, HT may lead to a series of related diseases, such as renal failure, dementia, and HT retinopathies (Christos et al. 2016). In view of this, it is necessary to develop effective drugs to treat individuals with HT. ...
... Given the effectiveness and speed, the radial basis kernel function (RBF) of SVM was applied in this study to discriminate AHTPs from non-AHTPs. The values of parameter C and γ were varied in the ranges [2 -5 , 2 15 ] (Christos et al. 2016;Puchalska et al., 2014;Husserl and Messerli 1981;Hong et al. 2008) ...
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Hypertension is a terrible disease, which has been threatened the health of 25% of the population. Therefore, it is an urgent task to develop a safe and effective drug to treat patients with hypertension. Fortunately, recent study found that antihypertensive peptides (AHTPs) may become a promising medicine for cure of hypertension. A challenging job is how to discriminate AHTPs from non-AHTPs. With the development of machine learning, more and more researchers draw their attention on computational models. In view of this, we proposed a novel computational approach called iAHTP-LH for identifying AHTPs. In the model, physicochemical properties were employed to encode peptide sequences. The Pearson’s correlation coefficient was used to describe important low-order and high-order correlation information. Furthermore, the canonical correlation analysis algorithm was applied to capture the interaction between different features. A feature selection strategy was adopted to reduce the influence of irrelevant and redundant features. Finally, these reserved features were fed into support vector machine for distinguishing AHTPs from non-AHTPs. The proposed method achieved 0.9574 and 0.9609 AUC value on the benchmark and independent dataset, it means that our proposed method is effective, and has significantly improvement on the classification performance, as compared with the existing predictors. The datasets and codes were available at https://figshare.com/articles/online_resource/iAHTP-LH/18838889.
... Also as previous studies have shown, HTN emergency may occur in patients without a known history of HTN. 17 As a result, health providers and physicians should be aware of the relation between NSAID use among those with an underlying disorder and therefore prescribe NSAIDs with extra caution and try to limit their use to only when it is necessary to prevent adverse events and HTN-C. ...
... Not to mention that HTN emergencies are also more common in older age. 17 There are inconsistent data about the prevalence of HTN-C among different genders. 17,20 On the other hand, NSAID use is reported to be higher in the female sex. ...
... 17 There are inconsistent data about the prevalence of HTN-C among different genders. 17,20 On the other hand, NSAID use is reported to be higher in the female sex. 21 Wastesson et al also studied paracetamol use among Nordic countries and their investigations showed that this drug is being purchased more by women. ...
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Backgound One of the known risk factors for hypertensive crisis (HTN-C) is non-steroidal anti-inflammatory drugs (NSAIDs) which their adverse effects can lead to end-organ damage such as gastrointestinal and cardiovascular issues. Aims Data on the correlation between NSAIDs and HTN-C are limited. In this study, we determined the prevalence of NSAID use among patients with HTN-C. Materials & Methods This cross-sectional study was conducted among patients primarily diagnosed with HTN-C referred to Alzahra hospital, Shiraz, Iran from April 2015 to April 2020. Demographic data, as well as information regarding the past medical and drug history and laboratory findings, were gathered retrospectively. The history of NSAID use was also asked specifically. The collected data were analyzed by SPSS and the P-value less than .05 was considered significant. Results A total of 257 patients with a mean age of 59.73 were enrolled in the study. Among them 62.6% were female and 137 patients (53.33%) used NSAIDs. Of all the patients 197 (76.7%), 71 (27.6%), and 46 (17.9%) suffered from concomitant hypertension (HTN), diabetes mellitus (DM), and ischemic heart disease (IHD) respectively. A significant relation was found between having each of the comorbidities and NSAIDs use among HTN-C patients (P-value <.0001). NSAIDs use was also significantly higher in older age (P-value <.0001) and female gender (P-value <.02). A high rate of NSAID use was seen among HTN-C patients with a positive significant correlation to concomitant diseases, older age, and female gender. Conclusion The Results of our study indicate that NSAIDs are frequently used among those with HTN-C and considering the adverse effects of these medication our results further highlight the importance of monitoring and limiting NSAID use.
... Despite increasingly effective pharmacotherapy and a greater awareness of hypertension and its complications, this condition is still particularly dangerous [6]. For many years, it can proceed asymptomatically or it can display non-specific symptoms and is often diagnosed incidentally [7]. There are several organ complications, collectively referred to as hypertension-mediated organ damage (HMOD) in the course of vascular lesions that accompany hypertension, such as vascular endothelial damage, remodeling of small and large arteries, and vascular rarefaction [8]. ...
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The number of patients with arterial hypertension is continually increasing. Hypertension can cause organ complications, called hypertension-mediated organ damage (HMOD). One example is hypertensive retinopathy, in which high blood pressure (BP) damages both the retinal microcirculation and the retinal nerve fiber layer (RNFL). This can result in progressive and painless vision deterioration in some groups of patients. Unlike anywhere else in the human body, the microvasculature of the retina can be observed in vivo, and the progression of changes can be closely monitored. The harmful effect of increased BP on the eye is not only limited to hypertensive retinopathy, but can also lead to an exacerbation of diabetic retinopathy (DR) and to an increase in intraocular pressure (IOP), and it can also trigger the formation of thromboembolic lesions. This review presents an update on the pathogenesis of hypertensive retinopathy and the use of adaptive optics (AO) combined with optical coherence tomography (OCT) to evaluate the retinal microvasculature. The latest progress and directions of research in the field of hypertensive retinopathy are also discussed.
... Acute renal failure is another manifestation of hypertensive emergency. 5 Differences in the amount of cardiac output received, total oxygen consumption, and auto-regulatory capacity (i.e., auto-regulatory dependence) may explain some of the differences in the prevalence of individual organ dysfunction. 6 Although hypertensive emergencies can lead to significant morbidity and potentially fatal target organ damage, only 1-3% of patients with hypertension will have a hypertensive emergency during their lifetime. ...
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Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.
... Hypertension disease impacts the health of 25% of the global population (Manavalan et al. 2018). In addition to heart diseases, it can also cause other functional abnormalities, like renal failure, multi-infarct dementia, and amputation (Varounis et al. 2017). At present, it has been reported that there are a number of types of drugs obtainable for the treatment of cancer and hypertension disease. ...
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Peptide drugs are generally compounds with 2–50 amino acids connected by peptide bonds and having drug effects. Because of their unique advantages such as significant activity, strong specificity, and low toxicity, some of them are applied in the treatment of various diseases. The design and development of new peptide drugs have broad prospects, and determining the molecular characteristics of disease-related peptide drugs is the key to drug design. This research takes anti-cancer peptides and anti-hypertensive peptides as the research objects, and we propose a novel method of describing peptide drugs, making use of the topological attribute values in an amino acid interaction network to represent the characteristics of peptides. In addition, peptide drugs are described from different perspectives by combining the information of the primary, secondary and tertiary structures. Three algorithms including support vector machine (SVM), K-nearest neighbor (KNN) and random forest (RF) are utilized to train the model. Then the support vector machine based on recursive feature elimination method (SVM-RFE) removes redundant features and identifies the key characteristics of different types of drugs. The added network features can more comprehensively describe peptide drugs, providing a theoretical basis for the analysis and design of new peptide drugs. The web sever of ACHP is freely available at http://118.178.58.31:9801/. Graphic Abstract
... For patients with hypertensive crisis, urgent reduction in BP is typically not required, except among patients with HTN-E [1,6]. The patient's target BP should not be set at a level much lower than the baseline BP [1]. ...
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Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
... In medical context, "crisis" is defined as a turning point or an important stage of a disease where the patient's situation becomes better or worse [1,2]. The term is usually used to describe the sudden exacerbation of various specific pathological conditions, such as hypertensive crisis [3], hyperglycemic crisis [4], adrenal crisis [5], and sickle cell anemia crisis [6]. The concept of the crisis is ancient in origin and, despite similarity in definition with the modern usage, the concept has had a much wider application and sophisticated conception in some historical medical schools, like Persian Medicine (PM) also known as Iranian Traditional ...
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The term “crisis” in medical context is an important turning point or stage which occurs in some diseases and if not managed correctly, can become life threatening. Despite the use of the term in modern medicine, it was a much wider and sophisticated traditional medical concept. The first usage has been seen in the Greek writings of Hippocrates. In the Islamic Golden Age, this concept entered Persian Medicine by translation of Greek medical treatises. Great Persian Medicine scholars have paid particular attention to the concept and have written exclusive chapters about it. One of such scholars, Hakim Mohammad Azam Khan Chishti (1814-1902), an Indo-Persian physician and medical writer, wrote several comprehensive encyclopedic books - in Persian language - about various aspects of Persian Medicine including crises. In this historical review we discuss his biography and his books, especially his important book Rokn-e-Azam, which is a comprehensive work on the concept of crisis in which he collected and discussed opinions of great medical scholars from ancient times to the 19th century. Despite his fidelity, unfortunately he rarely criticized the previous literature and thus did not add an additional value to the subject else than his comprehensive review. In the recent worldwide accepted roadmap towards Integrative Medicine, studying such inclusive traditional manuscripts may give better insight and understanding of the behavior of acute and chronic diseases and their appearance, exacerbations and remissions.
... Hypertensive emergency is a life-threatening condition occurring when untreated hypertension exceeds the limits of organ blood flow autoregulation, typically with acutely increased blood pressure to 200/120 mmHg or higher (1). Subsequently, this can damage the brain, kidney, and heart, and the blood pressure needs to be controlled immediately in such patients to prevent further end-organ injury (1,2). ...
... Hypertensive emergency is a life-threatening condition occurring when untreated hypertension exceeds the limits of organ blood flow autoregulation, typically with acutely increased blood pressure to 200/120 mmHg or higher (1). Subsequently, this can damage the brain, kidney, and heart, and the blood pressure needs to be controlled immediately in such patients to prevent further end-organ injury (1,2). However, no biomarkers are currently available to support initial management of these patients (3,4). ...
... Although several c-miRs were associated with endothelial dysfunction, our findings did not support the hypothesis that ED through circulating microRNA act as a mediator of hypertensive emergency endorgan injury in the brain, kidney, and heart. The pathogenesis in hypertensive emergencies is not fully understood, but rapidly increased blood pressure caused by the failure of arteriolar autoregulation is postulated to cause ED, renin-angiotensin-aldosterone system activation, and a pro-thrombotic state leading to organ injury (1,45). We found deviations in the levels of c-miRs in animals suffering end-organ injuries, raising the possibility that miRs are involved in the hypertensive emergency pathogenesis. ...
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There is an incomplete understanding of the underlying pathophysiology in hypertensive emergencies, where severely elevated blood pressure causes acute end-organ injuries, as opposed to the long-term manifestations of chronic hypertension. Furthermore, current biomarkers are unable to detect early end-organ injuries like hypertensive encephalopathy and renal thrombotic microangiopathy. We hypothesized that circulating microRNAs (c-miRs) could identify acute and chronic complications of severe hypertension, and that combinations of c-miRs could elucidate important pathways involved. We studied the diagnostic accuracy of 145 c-miRs in Dahl salt-sensitive rats fed either a low-salt (N = 20: 0.3% NaCl) or a high-salt (N = 60: 8% NaCl) diet. Subclinical hypertensive encephalopathy and thrombotic microangiopathy were diagnosed by histopathology. In addition, heart failure with preserved ejection fraction was evaluated with echocardiography and N-terminal pro-brain natriuretic peptide; and endothelial dysfunction was studied using acetylcholine-induced aorta ring relaxation. Systolic blood pressure increased severely in animals on a high-salt diet (high-salt 205 ± 20 mm Hg vs. low-salt 152 ± 18 mm Hg, p < 0.001). Partial least squares discriminant analysis revealed 68 c-miRs discriminating between animals with and without hypertensive emergency complications. Twenty-nine c-miRs were strongly associated with hypertensive encephalopathy, 24 c-miRs with thrombotic microangiopathy, 30 c-miRs with heart failure with preserved ejection fraction, and 28 c-miRs with endothelial dysfunction. Hypertensive encephalopathy, thrombotic microangiopathy and heart failure with preserved ejection fraction were associated with deviations in many of the same c-miRs, whereas endothelial dysfunction was associated with a different set of c-miRs. Several of these c-miRs demonstrated fair to good diagnostic accuracy for a composite outcome of hypertensive encephalopathy, thrombotic microangiopathy and heart failure with preserved ejection fraction in receiver-operating-curve analyses (area-under-curve 0.75–0.88). Target prediction revealed an enrichment of genes related to several pathways relevant for cardiovascular disease (e.g., mucin type O-glycan biosynthesis, MAPK, Wnt, Hippo, and TGF-beta signaling). C-miRs could potentially serve as biomarkers of severe hypertensive end-organ injuries and elucidate important pathways involved.
... The pathology of HCs is not fully understood; however, 2 interrelated mechanisms of the sympathoadrenal system appear to contribute to HCs. 4,5 The first contributing mechanism to HC is failure in autoregulation of BP at the level of the vascular bed. Under normal circumstances, an abrupt increase or decrease in BP would be compensated by autoregulatory mechanism such as a change in vascular tone. ...
... Failure of this autoregulation in the presence of increased BP and systemic vascular resistance would ultimately lead to a HC. 4 The second mechanism that may incite a HC is systemic peripheral vasoconstriction ensuing from angiotensin II. The latter is the result of upregulation of the renin-angiotensin-aldosterone system. ...
... The latter is the result of upregulation of the renin-angiotensin-aldosterone system. 4 In the presence of severe hypertension, a reflex vasodilation induced by the endothelium vasoactive hormones, such as nitric oxide and prostacyclin, attempts to reestablish normotensive equilibrium. Despite this, increased vascular resistance persists, and vasodilator stores become depleted. ...
Article
Hypertensive crises (HCs) are common occurrences and can result in immediate or delayed organ damage. Given the complex pathophysiological process associated with HCs, selecting the appropriate treatment can be a challenge. The goal of this report is to provide nurse practitioners with an up-to-date and evidence-based mnemonic tool to help effectively manage HCs. Using an alphabetized mnemonic provides nurse practitioners with quick recall into the treatment options of HCs. The ABCD mnemonic will cover antihypertensive drug classes such as Arterial/venous dilators, Beta (β)-blockers, Calcium channel blockers, and Diuretics.
... A. Acute cardiogenic pulmonary edema or flash pulmonary edema: Acute cardiogenic pulmonary edema from severe hypertension is treated with nitroprusside or nitroglycerine [29,30]. The use of intravenous loop diuretics may have adverse effects in such a scenario. ...
... The use of intravenous loop diuretics may have adverse effects in such a scenario. Intravenous loop diuretics may lead to volume depletion and hemodynamic side effects [21][22][23]29,30]. If nitroglycerin or nitroprusside infusion is not available readily, then sublingual nitroglycerin tablets with repeated administration until desired BP is achieved can be used. ...
... B. Aortic dissection: The BP in the setting of acute aortic dissection must be corrected immediately rather than normalizing slowly as is done with other presentations of hypertensive emergencies. Beta blockade prior to vasodilation for aggressive blood pressure reduction to decrease the shear force and afterload [30][31]. ...
Article
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Severe hypertension is the systolic blood pressure of 180 mmHg or above and/or diastolic blood pressure of 120 mmHg or above. Hypertensive urgency is defined as severe hypertension in the absence of any signs or symptoms of acute or ongoing end-organ damage. Hypertensive emergency is defined as the presence of severe hypertension with evidence of acute, life-threatening end-organ damage. Signs of end-organ damage include acute renal failure or malignant sclerosis, acute aortic dissection, acute pulmonary edema, acute coronary syndrome, retinal hemorrhages, papilledema, subarachnoid or intracerebral hemorrhage, and hypertensive encephalopathy. Patients with a hypertensive emergency need to be treated with intravenous antihypertensive agents for rapid titration and aggressive control of blood pressure. Patients with hypertensive urgency can be treated with oral antihypertensive medications to gradually lower the blood pressure over several hours to days.