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Hypertensive emergency is characterized by acute hypertension-mediated organ damage but also a life-threatening status

Hypertension Research volume 43, pages 1457–1458 (2020)Cite this article

We analyzed the definitions of hypertensive emergency (HTN-E) in the guidelines for arterial hypertension (HTN) and assessed the consistency of the HTN-E definition using the listed examples (Table 1).

Table 1 Elements of the definition of hypertensive emergency in various guidelines/position documents
Full size table

HTN-Es are very dangerous [1,2,3,4,5,6,7,8,9,10,11]. When epistaxis occurs with/following very high BP, it represents an acute lesion of the artery (i.e., acute hypertension-mediated organ damage (HMOD)) [5]. Bleeding usually occurs due to destruction of the arterial vessel wall (often from Kiesselbach’s plexus). Therefore, epistaxis can be regarded as a HTN-E by definition, but from the list of examples, the opposite can be concluded, which is a contradiction.

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References

  1. van den Born BJ, Beutler JJ, Gaillard CA, de Gooijer A, van den Meiracker AH, Kroon AA. Dutch guideline for the management of hypertensive crisis—2010 revision. Neth J Med. 2011;69:248–55.

    PubMed  Google Scholar 

  2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.

    Article  CAS  Google Scholar 

  3. Academy of Medicine of Malaysia. The Clinical Practice Guidelines (CPGs); Management of Hypertension (5th ed.). 2018. http://www.acadmed.org.my/index.cfm?menuid=67

  4. van den Born BH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E, et al. ESC Council on hypertension position document on the management of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother. 2019;5:37–46.

    Article  Google Scholar 

  5. Kenya National Guidelines for Cardiovascular Diseases Management. Developed by the division of non-communicable diseases—Ministry of Health. 2018. http://www.health.go.ke/wp-content/uploads/2018/06/Cardiovascular-guidelines-2018_A4_Final.pdf.

  6. Seedat YK, Rayner BL, Veriava Y, Hypertension guideline working group. South African hypertension practice guideline 2014. Cardiovasc J Afr. 2014;25:288–94.

    Article  CAS  Google Scholar 

  7. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138:e426–e483.

    PubMed  Google Scholar 

  8. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  9. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159–219.

    Article  Google Scholar 

  10. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.

    Article  Google Scholar 

  11. Wolf SJ, Lo B, Shih RD, Smith MD, Fesmire FM. Clinical policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure. Ann Emerg Med. 2013;62:59–68.

    Article  Google Scholar 

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Acknowledgements

This work has been supported by the Serbian Ministry of Education and Science, Belgrade, Serbia (Grant No. 175092 and III41018).

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Authors and Affiliations

  1. Department for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia

    Goran Koracevic

  2. Faculty of Medicine, University of Nis, Nis, Serbia

    Goran Koracevic, Dragan Djordjevic & Maja Koracevic

  3. Clinic for Internal Diseases Inter Medica, Nis, Serbia

    Dragan Lovic

  4. Singidunum University, School of Medicine, Nis, Serbia

    Dragan Lovic

  5. Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia

    Milovan Stojanovic & Dragan Djordjevic

  6. Innovation Center, University of Nis, Nis, Serbia

    Maja Koracevic

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Correspondence to Milovan Stojanovic.

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Koracevic, G., Lovic, D., Stojanovic, M. et al. Hypertensive emergency is characterized by acute hypertension-mediated organ damage but also a life-threatening status. Hypertens Res 43, 1457–1458 (2020). https://doi.org/10.1038/s41440-020-0501-6

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