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Hypertensive Emergencies: a New Clinical Approach

Abstract

Alfonso Lagi and Simone Cencetti

A variety of diseases are included in the expression ‘hypertensive urgencies’. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs.

The aim of the review was to define the idea of the ‘Acute hypertension’ as a new concept. Acute hypertension might be related to ‘organ damage’ because it is the cause, the consequence or an effect of the acute stress.

The structure of the search strategy included a literature search of PubMed, Medline, Cochrane Library and Google Scholar databases. The following inclusion criteria were applied: prospective double-blind randomised controlled trials; experimental animal work studies; case-control studies, recruiting patients representative of the general sick population. The review included analyses of 373 articles.

This review highlights a novel idea: acute hypertension is a common sign of different diseases characterized by sudden surge of arterial pressure, so overwhelming the difference between hypertensive emergencies and urgencies. The judgment of acute hypertension is independent of the initial arterial pressure, normotension or hypertension, and is linked with the transient failure of the baroreflex.

The ‘hypertensive emergencies’ have been grouped together in three subsets: 1) diseases that result from acute hypertension that is caused by faulty regulation of the peripheral circulation (acute primary hypertension); 2) diseases that produce hypertension by a specific pathogenesis (acute secondary hypertension); and 3) diseases that have hypertension as an effect of the acute stress caused by the principle disease (acute associated hypertension). Hypertensive emergencies are grouped together because all of these diseases require prompt therapy to prevent the negative outcomes of acute hypertension.