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Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit
Nobre, Fernando;Chauchar, Fause;Viana, Jaciara Machado;Pereira, Gustavo José Veras;Lima, Nereida Kilza da Costa;
Arquivos Brasileiros de Cardiologia , 2002, DOI: 10.1590/S0066-782X2002000200003
Abstract: objective: to evaluate the characteristics of the patients receiving medical care in the ambulatory of hypertension of the emergency department, division of cardiology, and in the emergency unit of the clinical hospital of the ribeir?o preto medical school. methods: using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. the characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between january 1996 and december 1997. results: the care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. thus, in the emergency unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. in 50% of the cases, nifedipine sl was the elected medication. patients who applied to the ambulatory of hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. conclusion: the therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. in the emergency unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the ambulatory of hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. these results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.
Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit
Nobre Fernando,Chauchar Fause,Viana Jaciara Machado,Pereira Gustavo José Veras
Arquivos Brasileiros de Cardiologia , 2002,
Abstract: OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeir o Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.
Comportamiento de las crisis hipertensivas en un centro médico de diagnóstico integral
Curbelo Serrano,Vladimir; Quevedo Freites,Gilberto; Leyva Delgado,Leovigildo; Ferrá García,Bárbara María;
Revista Cubana de Medicina General Integral , 2009,
Abstract: a descriptive and retrospective study was carried out to describe the behavior of hypertensive crises in emergency room of "carvajal" integral diagnosis medical center from this municipality in trujillo state, venezuela from january to june, 2007. universe included 104 patients diagnosed with hypertensive crises seen in emergency room during above period. for data collection charge records and micro-medical records were used as well as absolute end relative frequencies (percentage) to summarize the information and tables for its presentation. there was a male predominance, 50-59 years age group, and a great frequency of hypertensive urgencies. encephalic vascular accidents (strokes) and the acute coronary syndrome, as well as left ventricle atrophy and rise of st-segment within the electrocardiographic alterations, were the more significant.
Intravenous clevidipine for management of hypertension
Alma Rivera, Elsa Montoya, Joseph Varon
Integrated Blood Pressure Control , 2010, DOI: http://dx.doi.org/10.2147/IBPC.S6536
Abstract: travenous clevidipine for management of hypertension Review (3028) Total Article Views Authors: Alma Rivera, Elsa Montoya, Joseph Varon Published Date June 2010 Volume 2010:3 Pages 105 - 111 DOI: http://dx.doi.org/10.2147/IBPC.S6536 Alma Rivera1, Elsa Montoya2, Joseph Varon3 1Universidad Autónoma de Chihuahua, Chihuahua, México; 2Universidad de Monterrey, Nuevo León, México; 3University of Texas Health Science Center at Houston, Texas, USA Abstract: Hypertension remains one of the most prevalent diseases affecting our society, and its complications lead the list of causes of mortality all over the world. Most efforts to control the disease are unsuccessful, failing in at least two-thirds of affected patients, despite the availability of multiple drugs for its treatment. The limited number of medications available for aggressive management of hypertensive crises has intensified the search for novel drugs that can achieve a rapid decrease in blood pressure without increasing the possible complications. Clevidipine is a novel, vasculoselective, dihydropyridine calcium channel blocker characterized by a very fast onset and offset of action. Metabolism of clevidipine does not occur in the liver or kidneys, and thus there are no restrictions to using clevidipine in patients with hepatic or renal dysfunction. This agent has been widely used to reduce blood pressure when oral therapy is not appropriate, and its use in the perioperative setting has been shown to be beneficial. This manuscript reviews the key characteristics of clevidipine and its role in the management of acute hypertension.
Urapidil in the treatment of medical emergencies caused by blood pressure increase
N.I. Gaponova1,V.R. A bdrakhmanov,S.N.Tereschenko
Rational Pharmacotherapy in Cardiology , 2012,
Abstract: Results of experimental and clinical studies devoted to urapidil combining central antihypertensive effect with peripheral vasodilatation are discussed. Scope of urapidil application is described; its good tolerability and safety are highlighted. Urapidil mode of application in different clinical situations accompanying by acute increase in blood pressure is specified.
Clinical review: The management of hypertensive crises
Joseph Varon, Paul E Marik
Critical Care , 2003, DOI: 10.1186/cc2351
Abstract: Hypertension is an exceedingly common disorder in Western societies, and as such practitioners of most clinical specialties are likely to encounter patients with acute, severe elevations in blood pressure. In particular, hypertensive emergencies and hypertensive urgencies (see the section on Teminology, definitions, and misconceptions, below) are commonly encountered in the emergency department, operating room, postanaesthesia care unit, and intensive care units [1-8]. The most important factor that limits morbidity and mortality from these disorders is prompt and carefully considered therapy [9]. Unfortunately, hypertensive emergencies and urgencies are among the most misunderstood and mismanaged of acute medical problems seen today. Indeed, the reflex of rapidly lowering an elevated blood pressure is associated with significant morbidity and death. Clinicians dealing with hypertensive emergencies and urgencies should be familiar with the pathophysiology of the disease and the principles of treatment. This article reviews current concepts, and common misconceptions and pitfalls in the diagnosis and management of patients with severe hypertension.Efforts to classify hypertension on the basis of specific values have existed for the past 100 years. In the USA, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified hypertension according to the degree of elevation in blood pressure [1,10]. According to the most recent report by this committee (the JNC 7 Report [10]), patients with stage 1 hypertension have a systolic blood pressure of 140–159 mmHg or a diastolic blood pressure of 90–99 mmHg. Those patients with stage 2 hypertension have a systolic blood pressure greater than 160 mmHg or a diastolic blood pressure greater than 100 mmHg. Although not specifically addressed in the JNC 7 Report, patients with a systolic blood pressure greater than 179 mmHg or a diastolic blood pressure that is greater than 109
Comportamiento de las crisis hipertensivas en un centro médico de diagnóstico integral Behavior of the hypertensive crisis present in patients from an integral diagnosis medical center
Vladimir Curbelo Serrano,Gilberto Quevedo Freites,Leovigildo Leyva Delgado,Bárbara María Ferrá García
Revista Cubana de Medicina General Integral , 2009,
Abstract: Se realizó un estudio descriptivo y retrospectivo, con el objetivo de describir el comportamiento de las crisis hipertensivas en el Cuerpo de Guardia del Centro Médico de Diagnóstico Integral "Carvajal", del municipio del mismo nombre, en el estado de Trujillo, Venezuela, en el período de enero a junio de 2007. Se trabajó con un universo de 104 pacientes diagnosticados con crisis hipertensivas que acudieron al cuerpo de guardia en el período mencionado. Para la recogida de los datos se utilizaron las hojas de cargo y las microhistorias. Se emplearon frecuencias absolutas y relativas (porcentaje) para resumir la información, y tablas para su presentación. Se obtuvo un predominio del sexo masculino, el grupo de edades de 50-59 a os y una mayor frecuencia de las urgencias hipertensivas. Los accidentes vasculares encefálicos y el síndrome coronario agudo, así como la hipertrofia del ventrículo izquierdo y la elevación del segmento ST dentro de las alteraciones electrocardiográficas, fueron las de mayor significación. A descriptive and retrospective study was carried out to describe the behavior of hypertensive crises in Emergency Room of "Carvajal" Integral Diagnosis Medical Center from this municipality in Trujillo state, Venezuela from January to June, 2007. Universe included 104 patients diagnosed with hypertensive crises seen in emergency room during above period. For data collection charge records and micro-medical records were used as well as absolute end relative frequencies (percentage) to summarize the information and tables for its presentation. There was a male predominance, 50-59 years age group, and a great frequency of hypertensive urgencies. Encephalic vascular accidents (strokes) and the acute coronary syndrome, as well as left ventricle atrophy and rise of ST-segment within the electrocardiographic alterations, were the more significant.
Diagnosis and treatment of hypertensive crises in the elderly patients
Joseph Varon,Neil E Strickman,
Joseph Varon
,Neil E. Strickman

老年心脏病学杂志(英文版) , 2007,
Abstract: Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.
STROKE IN HYPERTENSIVE PATIENTS
SHAKEEL UR REHMAN
The Professional Medical Journal , 2004,
Abstract: Objective: To compare the incidence of intracerebralhaemorrhage and cerebral infarction in hypertensive patients in stroke. Design: Prospective study:Setting: Medical Unit II Allied Hospital Faisalabad. Period: From 1st Aug 2000 to 15th April 2001.Material & Method: 100 patients admitted to medical unit II, with a completed stroke along withhypertension. Stroke was suspected on clinical examination and for confirming the diagnosis, CT scanfacilities were made available. Out of 100, 65 were males and 35 were females. 73 patients had infarctivestroke, 22 had a haemorrhagic stroke and 5 patients had subarachnoid hemorrhage. Results: Patientswere divided into various sub groups according to age, sex, type of stroke and risk factors. The resultswere tabulated as per outcome on CT brain. 73 patients had infarctive stroke, 22 had a hemorrhagicstroke and 5 patients had SA hemorrhage. Conclusion: Hypertension is risk factor in stroke and shouldbe properly controlled.
Life style of patient before and after diagnosis of hypertension in Kathmandu  [PDF]
Radha Acharya, Hom Nath Chalise
Health (Health) , 2011, DOI: 10.4236/health.2011.38081
Abstract: Hypertension is an important public health-challenge in the developing and the developed world alike. However, hospital-based studies on cardiovascular diseases including hypertension in a developing country like Nepal have been limited. Objective: The objective of the present study was to determine the life style of patients before and after diagnosis of hypertension. Methods: A total of 100 adult hypertensive patients over 30 years of age who were attending in medical out patients department within 6 month to 2 years after first diagnosis of hypertension in Shahid Gangalal National Heart Centre and Tribhuvan University Teaching Hospital, in Kathmandu, Nepal, in April 2009, using a descriptive research design. The data was collected by interview using a questionnaire consisting of a combination of structured and semistructured questions. The data was analyzed by using SPSS 11.5 version. Results: This study found the respondents’ knowledge regarding hypertension was poor. Regarding life style of hypertensive patients, majorities (90%) of them were non-vegetarian before diagnosis but after diagnosis of hypertension the percentage of non-vegetarian was reduced by 10%. Similarly, the reduction in consumption of meat, eggs, ghee and oil (mustard, sunflower) by hypertensive patients was statistically significant difference (p = 0.000) after the diagnosis of hypertension. Regarding soyabean oil consumption, additional salty food and amount of salt intake there was no statistical significant difference before and after the diagnosis of hypertension. Likewise, physical exercise and stress reduction activities performed by hypertensive patients and change in drinking alcohol and smoking was found to be statistically significant difference (p = 0.000) after the diagnosis of hypertension. Conclusion: The adverse consequences of hypertension can be reduced by modifying the life style. Therefore more focus should be given in increasing the awareness about hypertension by developing information, education and communication materials on hypertension and setting up hypertensive counseling clinic in each hospitals.
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