Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review.

Mariagiovanna Cantone,Luisa Vinciguerra,Giuseppe Lanza,Manuela Pennisi,Valentina Puglisi,Francesco Fisicaro,Rita Bella,Rosella Ciurleo,Alessia Bramanti,Jaime Mandelli

doi:10.3390/brainsci11010070

Abstract

Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.

Highlights

We provided a timely update on current treatment, debated issues, and future directions for hypertensive crisis in patients referred to the emergency department (ED) because of acute cerebrovascular events
In the placebo group, antihypertensive therapy was not associated with less favorable outcomes at three months, whereas post-randomization antihypertensive therapy was associated with less favorable outcomes for the rtPA patients who were hypertensive
The increase in BP can be secondary to the stress caused by several factors, including the cerebrovascular event itself, a pre-existing hypertension, pain, urinary retention, or it can be a physiological response to hypoxia or increased intracranial pressure [98,116,118,119]

Summary

Introduction

Arterial hypertension is the main risk factor for cardio- and cerebrovascular diseases in Western countries [1,2,3,4,5,6]. It is estimated that the majority of patients presenting at the emergency department (ED) with hypertensive crisis, defined as an increase in systolic blood pressure (SBP) higher than 179 mmHg or diastolic blood pressure (DBP) higher than 109 mmHg [7], have had poor control of the arterial BP in the previous months. Epidemiological data show that only 17.4% of patients with arterial hypertension achieve adequate BP control [8,9]. Progress has been made in understanding the pathophysiology of hypertension and its complications.

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Results

Discussion

Conclusion