Approach and intervention in blood pressure abnormalities

Year 2023, Volume: 4 Issue: 6, 710 - 714, 31.12.2023

Zekiye Nur Haktanıyan , Artuner Varlıbaş , Aydın Çifci

https://doi.org/10.47582/jompac.1398083

Abstract

Hypertension is when blood pressure (BP) is measured above the limits of what is considered normal. Almost all guidelines define hypertension as a systolic blood pressure (SBP) above 140 mmHg and a diastolic blood pressure (DBP) above 90 mmHg. Blood pressure should not be seen only as a numerical value that should be monitored and lowered when it rises. Blood pressure is an important vital sign that can provide important clues to the clinician about the patient's current condition. Long-term control of hypertension in individuals significantly reduces cardiovascular risk. In the case of hypertensive emergencies or urgent situations, antihypertensive treatment should be initiated after consideration of the approach to the recommendations. Recent observational studies suggest that pharmacologic treatment of acute and asymptomatic in-hospital BP elevations may not be beneficial and may even increase the risk of in-hospital and post-discharge complications. The patient's current clinical status and additional comorbidities should be evaluated, and attention should be paid to contraindications and drug dosage adjustments.

Keywords

Hypertension, systolic blood pressure, diastolic blood pressure

Hipertansif anomaliler ve klinikte yönetim

Abstract

Hipertansiyon, kan basıncının normal sınırları aştığı bir durumdur, sistolik ve diastolik tansiyon 140 ve 90 mmHg'nin üzerindedir. Uzun süreli yüksek tansiyon kontrolü kalp ve damar riskini azaltırken, hastaneye konulan hastalarda akut kan basıncı artışı tartışmalı. Mevcut kılavuzlar hastanede belirtilmemiş kan basıncı artışlarını veya bunların teşhisini, yönetimini ve takiplerini ele almıyor. Son çalışmalar, farmakolojik tedavinin faydalı olmayabileceğini ve komplikasyon riskini artırabileceğini öne sürüyor. Toplumda hipertansiyonun tespiti ve tedavisi faydalıdır, ancak semptomatik ve kısa süreli kan basıncı artışlarının klinik önemi hakkında az şey bilinmektedir. Hastaneye konulan hastalarda akut yüksek tansiyonda her zaman antihipertansif tedavi gerektirmeyebilir, ancak güvenilir ölçüm protokolleri gereklidir.

Keywords

Yüksek Kan Basinci, İzlem, Kan Basinci Yönetimi

References

• 1. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-1357.
• 2. Mangoni AA, Jarmuzewska EA, Gabb GM, Russell P. Blood pressure elevations in hospital. Australian Prescriber. 2022;45(6):205.
• 3. Axon RN, Cousineau L, Egan BM. Prevalence and management of hypertension in the inpatient setting: a systematic review. J Hosp Med. 2011;6(7):417-422.
• 4. Aydoğdu S, Güler K, Bayram F, et al. Türk hipertansiyon uzlaşı raporu 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-546.
• 5. Umemura S, Arima H, Arima S. et al. The Japanese Society of Hypertension Guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42(9):1235-1481.
• 6. Penmatsa KR, Teki P, Gupta A. Hypertension in the hospitalized patient: an update. Nefrologia. 2021;41(6):605-611.
• 7. Orlov NM, Arora VM. Things we do for no reason™: routine overnight vital sign checks. J Hosp Med. 2020;15(5):272-274.
• 8. Axon RN, Cousineau L, Egan BM. Prevalence and management of hypertension in the inpatient setting: a systematic review. J Hosp Med. 2011;6(7):417-422.
• 9. Meadows C, Elhamdani M, Larry D, et al. Management of asymptomatic hypertension in the inpatient setting. Marshall J Med. 2023;9(3):5.
• 10. Mirdamadi A, Etebari M. Comparison of manual versus automated blood pressure measurement in intensive care unit, coronary care unit, and emergency room. ARYA Atherosclerosis. 2017;13(1):29.
• 11. Gauer R. Severe asymptomatic hypertension: evaluation and treatment. Am Fam Physician. 2017;95(8):492-500.
• 12. Rehman S, Hashmi MF, Nelson VL. Blood Pressure Measurement. [Updated 2022 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK482189/
• 13. Rodriguez MA, Kumar SK, De Caro M. Hypertensive crisis. Cardiol Rev. 2010;18(2):102-107.
• 14. Türk Kardiyoloji Derneği. 2013 Ulusal hipertansiyon tedavi ve takip klavuzu. Türk Kardiyoloji Derneği Arşivi [online]. Erişim adresi: http://www. tkd. org. tr/kilavuz/k03. htm Erişim tarihi, 22, 2023.
• 15. Pierin AMG, Flórido CF, Santos JD. Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department. Einstein (Sao Paulo). 2019;17(4):eAO4685.
• 16. Balahura AM, Moroi ŞI, Scafa-Udrişte A, et al. The management of hypertensive emergencies—is there a “magical” prescription for all? J Clin Med. 2022;11(11):3138.
• 17. Whelton PK, Carey RM, Mancia G, et al. Harmonization of the American College of Cardiology/ American Heart Association and European Society of Cardiology/European Society of Hypertension blood pressure/hypertension guidelines: comparisons, reflections, and recommendations. Eur Heart J. 2022;43(35):3302-3311.
• 18. Alley WD, Schick MA. Hypertensive Emergency. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih. gov/books/NBK470371/
• 19. Qureshi AI, Palesch YY, Foster LD, et al. Blood pressure-attained analysis of ATACH 2 trial. Stroke. 2018;9(6):1412-1418.
• 20. Garovic VD. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association. Hypertension. 2022;79(2):e21-e41.