Warning: Undefined variable $zfal in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 525
Deprecated: str_replace(): Passing null to parameter #3 ($subject) of type array|string is deprecated in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 525
Warning: Undefined variable $sterm in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 530
Warning: Undefined variable $sterm in C:\Inetpub\vhosts\kidney.de\httpdocs\mlpefetch.php on line 531
 
English Wikipedia
Nephropedia Template TP (
Twit Text
DeepDyve
Pubget Overpricing |  
lüll
Clinical presentation and management of patients with uncontrolled, severe hypertension: results from a public teaching hospital Preston RA; Baltodano NM; Cienki J; Materson BJJ Hum Hypertens 1999[Apr]; 13 (4): 249-55CONTEXT: There is relatively little data available on the management of patients with severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications. OBJECTIVE: To determine the incidence, clinical features, acute management, and clinical course of severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications presenting for emergency department care in a large public teaching hospital. DESIGN: Chart survey of consecutive emergency department visits. PATIENTS: Ninety-one of 2898 consecutive visits to a public teaching hospital emergency department were specifically for severe, uncomplicated hypertension. RESULTS: Of 2898 consecutive medical emergency department visits, there were 142 (4.9%) patient visits specifically for systolic blood pressure (SBP) > or =220 mm Hg or diastolic blood pressure (DBP) > or =120 mm Hg. Ninety-one of the 142 patient visits were for severe hypertension in the absence of acute target organ impact or neuroretinopathy. Eighty-nine patients received acute drug therapy. Twenty-nine patients received two drugs, and 15 received three drugs. Sixty-eight patients (75%) received clonidine, and 15 (16.5%) received short-acting nifedipine despite widely published concerns about the safety of this practice. We found a wide variability of blood pressure response to treatment. The average decline in SBP was 50+/-31 mm Hg and the average decline of DBP was 34+/-20 mm Hg over 4.2+/-2.9 h. Forty-two patients (46%) had the SBP reduced to less than 160 mm Hg, and 46 patients (50%) the DBP to less than 100 mm Hg. Long-term management and follow-up were suboptimal. Of 74 patients discharged from the emergency room, 22 patients (30%) returned because of uncontrolled hypertension within an average of 33+/-28 days, 10 patients with hypertensive complications. CONCLUSIONS: Severe hypertension continues to present an important and common problem. Physicians appear to place a strong emphasis on acute lowering of the blood pressure to near-normal levels. Patients are frequently lost to follow-up and have a very high rate of recurrent emergency department visits and hypertensive complications. This study points to a need for detailed, specific practice guidelines and comprehensive disease management protocols for severe, uncomplicated hypertension.|*Hospitals, Public[MESH]|*Hospitals, Teaching[MESH]|Acute Disease[MESH]|Antihypertensive Agents/*therapeutic use[MESH]|Blood Pressure/drug effects[MESH]|Calcium Channel Blockers/*therapeutic use[MESH]|Clonidine/*therapeutic use[MESH]|Cross-Sectional Studies[MESH]|Emergency Service, Hospital[MESH]|Female[MESH]|Florida/epidemiology[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Hypertension/*drug therapy/epidemiology[MESH]|Incidence[MESH]|Male[MESH]|Middle Aged[MESH]|Nifedipine/*therapeutic use[MESH]|Retrospective Studies[MESH]|Severity of Illness Index[MESH]|Treatment Outcome[MESH] |
