Acute Rise In Blood Pressure Research Articles

An Epidemiological Survey on the Assessment of Risk Factors during Pregnancy

Pregnancy is described as a condition or a state from the time of conception up to the time of delivery. The ‘high-risk’ pregnancy means a woman has one or more things that raise her-or her baby’s chances for health problems or preterm (early) delivery. High blood pressure, obesity, diabetes, epilepsy, thyroid disease, smoking, alcohol, using illegal drugs, heart or blood disorder, poorly controlled asthma, malnutrition anemia, multiple pregnancy, pregnancy history and infection can increase the risk of pregnancy. This study was basically a descriptive type of epidemiological study based on the concept of active surveillance. The elements involved to study were risk factors involved during pregnancy like Pre-eclampsia, Gestational Diabetes, Thyroid, delivery related complications and weight gain during pregnancy. The data obtained was categorized and analyzed using graphical representations as charts, graphs and other means. The descriptive responses were analyzed individaually. Out of 100, 27 women were suffering from complications during late age pregnancy include Gestational Diabetes, Thyroid, complications due to High Blood Pressure, Cyst in Uterus, Bed Rest due to previous Miscarriage, Bleeding in Second Trimester, Acute Body Pain, Acute Rise in Blood pressure. Premature delivery was seen due to late age pregnancy. 16 out of 100 women had premature delivery i.e in 33 to 35 weeks of pregnancy or 7th and 8th month of pregnancy. In late age pregnancy, there were total 59 responses out of 100, 27(45.7%) women facing problems due to late age pregnancy like high BP, stillbirth, death of fetus in womb, thyroid, gestational diabetes and complications during delivery and 54.20% women were not having any problems. Women who suffered pregnancy induced hypertension, out of 57women 17(29.82%) were facing problems like depression, anxiety, miscarriage, weakness, vomiting, nausea. Out of 100 women, 9 women suffered from gestational diabetes and 10 women had prolonged diabetes. So from above results, it is considered that women who are 35 years and above are considered to be at “high risk” for pregnancy. Women who were aged 22-30 years didn’t suffer from such diseases but gestational diabetes was observed in some cases. Women who were aged 28-35 years suffered miscarriage and abortion due to reasons unknown.

Abstract 17255: Local Gunfire Exposure is Associated With Acutely Increased Blood Pressure on the South Side of Chicago

Hypertension is a leading risk factor for cardiovascular disease, which is especially prevalent among minority urban patients. Our group and others have previously shown that socio-environmental factors such as crime and poverty raise cardiovascular risk. However, the acute effects of local urban gunfire on patients’ blood pressure are unknown. We hypothesized that local gunfire in our South Side Chicago community was temporally associated with an acute rise in blood pressure for nearby patients. We performed a retrospective cohort study including 7,564 patients aged 18-104 who completed two or more outpatient clinic visits within 1 year at our academic tertiary-care center on the South Side of Chicago. We included 41,554 pre-pandemic clinic visits and recorded the blood pressure for each visit. Local gunfire was measured using ShotSpotter®, a network of microphones installed throughout the South Side of Chicago, which locates gunshots using auditory triangulation. Datasets of gunfire incidents are publically available from ShotSpotter® including date/time and geolocation of incidents. We focused on incidents that occurred within 1 km of each patient’s address and between two clinic visit dates (33 days, on average). Our primary outcome was the change in systolic blood pressure between the two clinic appointments. We excluded patients whose antihypertensive regimen was changed at the first appointment. Next, we utilized a multivariate regression model to assess the relationship between incidents of gunfire and seasonally-adjusted changes in blood pressure. Between-visit gunshot exposure ranged from 1 to 1,793 per patient. We found that each incident of gunfire was associated with a statistically significant acute increase in systolic blood pressure (0.0033 mmHg increase per gunfire incident [0.0022, 0.0044], p<0.0001). Results were similar regardless of whether total round count or total gunfire incidents were considered. In this study of urban patients, incidence of gunfire within 1 km of a patient’s address was associated with an acute rise in blood pressure over approximately 1 month. These findings implicate the adverse impact of local gunfire exposure and environmental stress on blood pressure in adults on the South Side of Chicago.

Protocolo diagnóstico y tratamiento de las crisis hipertensivas

Hypertensive crises are clinical situations which involve an acute rise in blood pressure (BP) that require swift diagnosis and appropriate treatment to prevent increasing organic dysfunction. The clinical history, physical examination and elementary complementary tests will allow us to differentiate between two entities: hypertensive urgency and emergency. A hypertensive urgency is defined as raised BP without injury to a target organ. The therapeutic target will be to gradually reduce the BP in the following days using orally administered drugs with a long half-life. A hypertensive emergency involves raised BP associated with injury to a target organ (the heart, kidneys or cerebrovascular) and it is a life-threatening risk for the patient. It requires immediate intravenous antihypertensive treatment, continuous haemodynamic monitoring and a rapid partial fall in BP.

PS-BPC03-3: CARDIOVASCULAR EVENTS PREDICTION RELATED TO GENDER IN PATIENTS WITH HYPERTENSIVE EMERGENCIES IN 12-MONTHS FOLLOW-UP GREEK STUDY

Objective: Currently, epidemiological data on prognosis of patients with hypertensive crises (hC) are limited. The purpose of our study was to register the prevalence and clinical characteristics of patients with hypertensive urgencies (hU) and emergencies (hE) admitting to the emergency department (ED) and during hospitalization and a 12-month follow-up to record new end points in a Greek tertiary hospital. Design and method: The study population included patients reporting to the ED with acute rise in blood pressure (BP) (systolic BP >or = 180mmHg and/or diastolic BP >or = 120mmHg), categorizing as hE and hU depending on the presence or absence of acute hypertension-mediated target organ damage, respectively. In all patients the demographic and clinical information were registered for 12 consecutive months. In addition, there was a 12-month follow-up for new events. Results: Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had hU and 97(27.5%) had hE. The mean age of the hE patients was 73 ± 12years, 51.5% were males and 86.4% had a history of hypertension. During the study period 3 hE patients did not complete the follow-up. After stratification of hE population by gender, we created two subgroups, males and females, and analyzed the composite end point involving deaths or hospitalizations by cardiovascular causality. Men reported more composite events than women (21 vs 11 events, p = 0.042, hR for males 2.2, 95% CI 1.03–4.6). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus. Conclusions: The results indicate male gender as an independent risk factor for deaths or hospitalizations caused by cardiovascular disease in patients with hE. Our registry highlights the commitment for a more intensive follow-up of hE patients, especially for men, and underlines the need for further research in this pathological entity.

Abstract 12264: A Rare Case of Penetrating Aortic Ulcer Causing Hemopericardium and Its Management

Introduction: Penetrating Aortic Ulcer (PUA) is an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows hematoma formation within the medial layer of the aortic wall. As per our literature review, only one case of PUA causing hemopericardium has been reported. Case Presentation 66-year-old male with an unknown past medical history was bought in by the emergency medical services following a cardiac arrest. Initial rhythm was pulseless electrical activity and return of spontaneous circulation was achieved after ten mins of cardio-pulmonary resuscitation on the field. Initial echocardiogram was significant for a 4.6 cm ascending aorta with large hemopericardium causing tamponade physiology. CT chest with contrast revealed an ectatic ascending aorta with mild irregularity along the posteromedial wall, concerning for aortic leak secondary to a penetrating aortic ulcer (as indicated by the yellow arrow in the image below). Controlled pericardiocentesis was planned as a bridging therapy while awaiting transfer to a specialized cardiothoracic unit. But, the systolic blood pressure (SBP) rose to 170 mmHg when the chest tube was first inserted, worsening the hemopericardium. The patient's condition rapidly deteriorated, causing another cardiac arrest and death. Discussion The recommended treatment for Type A and B PUA-associated Intra Mural Hematoma is urgent surgical aortic graft placement. For hemodynamically unstable patients who cannot be taken for urgent surgery, The 2015 European Society of Cardiology guidelines recommend controlled pericardiocentesis to maintain a target SBP of 90 mmHg as a temporary measure. Conclusion In addition to aortic dissection, PAU should be considered in the differentials of patients with dilated ascending aorta and hemopericardium. An acute rise in blood pressure above 90 mmHg during pericardiocentesis is associated with worsening tamponade.

Malignant Hypertension and the Role of Ophthalmologists: A Review Article.

Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient’s life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice.

Isometric Resistance Training Is Recommended as a Safe and Effective Adjunct Therapy to Reduce Blood Pressure

ABSTRACT Most scientific organizations recommend isometric resistance training (IRT) to manage blood pressure (BP), whereas some still do not. A typical grip IRT program of 4 × 2-minute 30%-intensity efforts with 1–3-minute rest periods, performed ≥3×/week for ≥8 weeks, can be efficient, safe, and relatively inexpensive. It can help decrease resting BP at least as much as aerobic or dynamic resistance training. IRT can be as effective as one antihypertensive medication and likely lessens strokes and myocardial infarctions. It can be as safe as other exercise modes regarding acute BP rise and safer than aerobic exercise regarding cardiac demand. Grip IRT is currently more conducive than leg IRT to program delivery. These highlights come from an expert-panel consensus reached through a largely anonymous multistep process, agreeing with the organizations that support IRT. To follow the science on IRT and BP, exercise and health care practitioners should seek corroboration from the guidelines of multiple organizations.

GENDER AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY

Objective: Currently, epidemiological data on prognosis of patients with hypertensive crises (HC) are limited. The purpose of our study was to register the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) admitting to the emergency department (ED) and during hospitalization and a 12-month follow-up to record new end points in a Greek tertiary hospital. Design and method: The study population included patients reporting to the ED with acute rise in blood pressure (BP) (systolic BP> or = 180mmHg and/or diastolic BP> or = 120mmHg), categorizing as HE and HU depending on the presence or absence of acute hypertension-mediated target organ damage, respectively. In all patients the demographic and clinical information were registered for 12 consecutive months. In addition, there was a 12-month follow-up for new events. Results: Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had HU and 97(27.5%) had HE. The mean age of the HE patients was 73 ± 12years, 51.5% were males and 86.4% had a history of hypertension. During the study period 3 HE patients did not complete the follow-up. After stratification of HE population by gender, we created two subgroups, males and females, and analyzed the composite end point involving deaths or hospitalizations by cardiovascular causality. Men reported more composite events than women (21 vs 11 events, p = 0.042, HR for males 2.2, 95% CI 1.03–4.6). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus. Conclusions: The results indicate male gender as an independent risk factor for deaths or hospitalizations caused by cardiovascular disease in patients with HE. Our registry highlights the commitment for a more intensive follow-up of HE patients, especially for men, and underlines the need for further research in this pathological entity.

Hypertension after COVID-19 vaccination

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread across the world, killing more than 4 million individuals globally, with 240 million individuals being confirmed by laboratory tests. Among different therapeutic strategies to prevent SARS-CoV-2 infection, vaccines are the most promising approach for curbing the pandemic. They elicit an immune neutralizing response and thus offer protection against coronavirus disease 2019 (COVID-19). However, some questions regarding the safety of COVID-19 vaccines have been raised and based on sparse reports of severe systemic reactions after vaccination. Among these, evidences on the potential effect of vaccination on the acute rise in blood pressure have been recently accrued. Approved vaccines in Europe increase the endogenous synthesis of SARS-CoV-2 Spike proteins from a variety of cells. Once synthetized in the cells reached by the vaccine, the Spike proteins first assemble in the cytoplasm and then migrate to the cell surface to protrude with a native-like conformation. Spike proteins are recognized by the immune system which rapidly develops an immune response. Furthermore, the Spike proteins assembled in the cells which are eventually destroyed by the immune response circulate in the blood as free-floating forms. Free-floating Spike proteins may interact with angiotensin-converting enzyme 2 (ACE2) receptors leading to internalization, degradation, and dysregulation of the catalytic activities of these receptors. The consequent loss of ACE2 receptor activity leads to a rapid drop in the generation of angiotensin1,7 resulting from inactivation of angiotensin II. The imbalance between angiotensin II (overactivity) and of angiotensin1,7 (deficiency) might play a role in the genesis of acute elevation in blood pressure.

Posterior Reversible Encephalopathy Syndrome: A Narrative Review for Emergency Clinicians.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic disorder characterized by seizures, headache, altered mental status, and visual disturbances, and is often associated with acute hypertension. This narrative review provides a focused description of the presentation, diagnostic evaluation, and management of PRES. PRES is associated with a variety of factors, including acute rise in blood pressure, renal disease, preeclampsia/eclampsia, and immunosuppressive therapy. The pathophysiology is theorized to involve dysfunction of cerebral autoregulation leading to vascular leak or endothelial dysfunction resulting in vasogenic edema. In the emergency department (ED), clinical findings suggestive of PRES should prompt diagnostic testing focused on confirming the diagnosis and excluding other conditions that may present similarly. Laboratory studies are primarily useful for excluding alternative diagnoses. Computed tomography (CT) and, in particular, magnetic resonance imaging (MRI) are the recommended neuroimaging modalities for diagnosis. CT and MRI may demonstrate cerebral vasogenic edema, most often in the distribution of the posterior circulation. Treatment involves management of seizures, control of blood pressure if elevated, and treatment of any underlying trigger. PRES is a neurological disorder that is typically reversible if recognized on presentation and promptly and appropriately managed. This narrative review characterizes this condition for emergency clinicians.

Comparison of acute pressor effects of plain water, oral rehydration solution, and fruit juice ingestion in healthy young adults

Background and Objectives: Ingestion of plain water is associated with an acute rise in blood pressure, probably due to elicitation of a sympathetic reflex in patients with autonomic dysfunction. Whether the pressor response is similar in healthy individuals is disputed. Other types of fluid could have different effects. Comparison of the pressor effects of plain water ingestion with other types of fluids has been reported scantily. 
 Material and methods: In a cross-over experimental study, young medical students ingested 500 mL of plain water (PW), 500 mL of oral rehydration salt solution (ORS), or 400 mL of commercial fruit juice (FJ) on separate days, with at least two days’ gap. Their heart rate (HR) and blood pressure (BP: systolic, SBP and diastolic, DBP) were recorded before, immediately after (0 min), and at 2, 5, 20, and 40 min after fluid ingestion and compared with baseline values. 
 Results: Sixty nine apparently healthy medical students (40 males and 29 females, age range 18-24 years) participated in the study. Compared to baseline, SBP and DBP were significantly higher at 0, 2, and 5 min measurements with ORS and FJ; then lowered at 20 and 40 min. With the PW, BP changes were not significant at any time of measurement. In all experimental set ups, HR increased significantly at 0, 2, and 5 min and lowered to near baseline levels then after. 
 Conclusion: Ingestion of ORS and FJ, but not PW, is associated with acute pressor effects in healthy young adults. This finding could have implications on the choice of fluid for prophylaxis in hypotensive conditions such as blood donation, postural hypotension, and autonomic dysfunction.

Posterior reversible encephalopathy syndrome with guillain barre syndrome: rare, coincident and preventable

Posterior reversible encephalopathy syndrome (PRES) is clinico - radiologic entity associated with hypertensive emergency, autoimmune disease, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS) with PRES is a rare entity. Acute rise in blood pressure (BP) due to dysautonomia increases cerebral blood flow causing vasogenic edema, manifests with headache, nausea, vomiting, seizures, altered sensorium, visual abnormalities, and focal neuro deficits (1). MRI imaging characteristics of PRES consist of hyperintense areas in the parieto-occipital region and features of vasogenic edema. 59 year housewife presented with two days history of ascending weakness progressively involving neck, trunk and upper limbs. Clinical diagnosis of GBS was considered and plasmapheresis was started. She was treated with betablockers for high BP. Subsequently she developed generalized seizures and altered sensorium. She was intubated, ventilated and AED were introduced. MRI brain consistent with clinical suspicion of PRES (Fig 1). Antihypertensives were titrated with target BP ≤130/80 mm hg. Plasmapheresis course was completed, limb power improved and she was extubated. MRI Brain after two weeks revealed near complete interval regression of the lesions (Fig 2). Antihypertensives, antiepileptics were optimised, neurorehabilitation continued and she was discharged at two weeks with advice for rehabilitation for her motor weakness. Autonomic dysfunction which occurs in association with GBS is at times challenging particularly during plasmapheresis and may lead to this complication. It is important to be aware of this complication so that early recognition would avoid morbidity.

Hypertensive Emergencies

Approximately 33% of adults in the United States have high blood pressure; approximately 1% will present with a hypertensive emergency. Hypertension emergency is typically defined as a blood pressure great than 180/120 mmHg leading to end organ damage. However, it is important to note that an acute rise in blood pressure may also lead to end organ damage before achieving the blood pressure threshold. Therapeutic intervention should be a short-acting, easily titratable, intravenous antihypertensive medication based on the type of end-organ damage, pharmacokinetics, and comorbidities. This review focuses on presentations and treatment of hypertensive emergency.

Myogenic response reduction by high blood glucose levels in human retinal arterioles.

The effect of elevated blood glucose level on the myogenic response of human retinal arterioles to acute increases in blood pressure is investigated. METHODS The vascular response to raised blood pressure (Bayliss effect) was measured in 12 healthy volunteers by use of the retinal vessel analyzer (RVA). For a 9-minute period an on-line measurement of the diameter of a retinal branch arteriole was performed. After the first 3 minutes (baseline measurement) a second phase with 3 minutes of isometric exercise caused an acute rise in blood pressure, followed by 3 minutes of recovery (phase III). After the first session 100 g glucose were administered per os. After 30 minutes blood glucose was measured again and an identical second session was performed with higher blood glucose levels. The Wilcoxon test was used for statistical analysis. During the first session a rise in mean arterial pressure of 22.8 (8.4) mmHg was followed by an arterial vasoconstriction of 6.6 (1.7) %. The administration of 100 g glucose resulted in a significant rise in blood glucose levels within 30 minutes between the two sessions (4.35 mmol/L vs 7.46 mmol/L) (p=0.002). The blood pressure rise of 25.7 (7.3) mm Hg in the second session was associated with a significant loss in arterial vasoconstriction of 2.3 (1.4) % (session I vs session II p=0.002). The myogenic response of the arterial wall in human retinal arterioles was significantly reduced during acute rise of blood glucose levels. (Eur J Ophthalmol 2005; 15: 56-61).

Focal segmental glomerulosclerosis in children complicated by posterior reversible encephalopathy syndrome

An uncommon side effect of cyclosporine A (CsA) use is posterior reversible encephalopathy syndrome (PRES). PRES usually develops because of disturbed capacity of posterior cerebral blood flow to autoregulate an acute rise in blood pressure. We present the case of a 10-year-old girl who was previously diagnosed in our department with focal segmental glomerulosclerosis. She was treated with CsA and developed seizures, progressive loss of consciousness, and visual disturbance on the 7th day of treatment. Brain magnetic resonance imaging showed degeneration of white matter with diffuse demyelination in the parietal and posterior occipital lobes, consistent with the diagnosis of PRES. Cases of PRES reported in children are usually secondary to immunosuppressive therapy in oncological and haematological diseases. Our case is the fifth reported case of focal segmental glomerulosclerosis in children treated with CsA and complicated by PRES. Rapid recognition of PRES and stopping neurotoxic therapy early are essential for a good prognosis.

Vascular smooth muscle cell response to cyclic mechanical stretch and aortic dissection

Acute aortic dissection is the most common life-threatening vascular disease, with sudden onset of severe pain and a high fatality rate. The pulsatile nature of blood flow exposes vascular smooth muscle cells (VSMCs) in the vessel wall to cyclic mechanical stretch (CMS), which evokes VSMC death, phenotypic switching, and migration, leading to aortic dissection. We have revealed that CMS of rat aortic smooth muscle cells (RASMCs) caused JNK- and p38-dependent cell death and that a calcium channel blocker, azelnidipine and an angiotensin II receptor antagonist, olmesartan decreased the phosphorylation of JNK and p38 and, subsequently, decreased cell death by CMS. JNK and p38 inhibitors also inhibited CMS-induced cell death. In addition, we showed that the expression of Cxcl1 and Cx3cl1 chemokines was induced by CMS in a JNK-dependent manner. Expression of Cxcl1 was also induced in VSMCs by hypertension produced by abdominal aortic constriction in mouse. In addition, antagonists against the receptors for CXCL1 and CX3CL1 increased cell death, indicating that CXCL1 and CX3CL1 protect RASMCs from CMS-induced cell death. We also revealed that STAT1 is activated in RASMCs subjected to CMS. Taken together, these results indicate that CMS of VSMCs induces inflammation-related gene expression, including that of CXCL1 and CX3CL1, and activates JNK and p38 MAP kinases, which may play important roles in the stress response against CMS caused by acute rise in blood pressure.

Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy

Hypertensive retinopathy is seen frequently in patients with systemic hypertension and is usually asymptomatic. An acute rise in blood pressure may lead to exudative changes in the form of macular edema, hemorrhages, and serous macular detachment that can lead to visual decline. The authors report prompt resolution of exudative changes in a case of hypertensive retinopathy following intravitreal bevacizumab.

Efficacy of various antihypertensive drugs in the treatment of hypertension in the patients of end-stage renal disease leading to hemodialysis: a retrospective study

Background: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients.Methods: A retrospective study was carried out on the patients who attended the hemodialysis unit of Hakeem Abdul Hamid Centenary hospital from July 2015 to June 2016 (one year), data on antihypertensive drugs and blood pressure control (pre-dialysis and post-dialysis) were recorded and analyzed.Results: 68.75% patients on hemodialysis were suffering from hypertension and were on antihypertensive medication. A combination of Amlodipine and clonidine were the most frequently prescribed antihypertensive agents. Muscle cramps an acute rise in blood pressure and hypotension were the most frequently encountered intradialytic complications in these patients.Conclusions: Although a combination of amlodipine and clonidine was most frequently prescribed antihypertensive medication in these patients these drugs were associated with intradialytic complications like muscle cramps and hypotension. Amlodipine with beta-adrenoceptor blocker (metoprolol or bisoprolol) provided best control of blood pressure in these patients with least intradialytic complications.

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients. Methodology: A retrospective study was carried out on the patients who attended the Haemodialysis unit of Hakeem Abdul Hamid Centenary hospital from July 2015 to June-2016 (one year), data on antihypertensive drugs and blood pressure control (pre-dialysis and post-dialysis) were recorded and analyzed. Result: 68.75% patients on haemodialysis were suffering from hypertension and were on antihypertensive medication. A combination of amlodipine and clonidine were the most frequently prescribed antihypertensive agents. Muscle cramps an acute rise in blood pressure and hypotension were the most frequently encountered intradialytic complications in these patients. Conclusion: Although a combination of Amlodipine and Clonidine was most frequently prescribed antihypertensive medication in these patients these drugs were associated with intradialytic complications like muscle cramps and hypotension. Amlodipine with beta-adrenoceptor blocker (metoprolol or bisoprolol) provided best control of blood pressure in these patients with least intradialytic complications.

Abstract 167: Intracerebral Hemorrhage After Emergency Department Visits for Hypertension

Introduction: Although common, severe hypertension in the emergency department (ED) has not been well studied. Current guidelines recommend against aggressive treatment of acutely hypertensive ED patients without end-organ failure and instead recommend initiation of oral antihypertensive agents and outpatient follow-up. However, recent data suggests that intracerebral hemorrhage (ICH) often occurs shortly after an acute rise in blood pressure. Hypothesis: We hypothesized that patients discharged from the ED with hypertension face an increased risk of ICH in subsequent weeks. Methods: Using administrative claims data from CA, NY, and FL, we identified all patients discharged from the ED from 2005 through 2011 with a primary diagnosis of hypertension (ICD-9-CM codes 401-405). Patients were excluded if they were hospitalized from the ED or had prior histories of cerebrovascular disease at the index visit with hypertension. Using the Mantel-Haenszel estimator for matched data, we compared each patient’s odds of ICH during days 8-38 after ED discharge to the same patient’s odds during days 373-403 after discharge. This cohort-crossover design with a one-week washout period enabled individual patients to serve as their own controls, thereby minimizing confounding bias. Results: Among 552,569 patients discharged from the ED with a primary diagnosis of hypertension, 93 (0.017%) were diagnosed with ICH during days 8-38 after discharge compared to 70 (0.013%) during days 373-403 (OR 1.33, 95% CI 0.96-1.84). The odds of ICH were increased in certain subgroups of patients (≥60 years of age and those with secondary discharge diagnoses besides hypertension), but absolute risks were low in all subgroups. Conclusions: Contrary to our hypothesis, patients with ED visits for hypertension did not face an increased short-term risk of ICH after discharge. These findings support current guidelines for the ED management of patients with acute hypertension.