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Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome.
High Blood Press Cardiovasc Prev. 2018 Sep; 25(3):253-259.HB

Abstract

Uncontrolled hypertension is one of the most common determinant for the persistently high burden of cardiovascular (CV) disease, mostly including coronary artery disease (CAD) and hospital admissions due to acute coronary events. Markedly high blood pressure (BP) levels are also frequently observed during the acute phase of coronary syndromes (both ST-segment and non-ST-segment elevation myocardial infarction and unstable angina). In particular, a sustained raise of BP levels above 180/110 mmHg associated with acute cardiac organ damage, i.e. myocardial ischemia, represents a condition of hypertension emergency and requires rapid hospital admission, prompt pharmacological therapies and non-pharmacological interventions, aimed at restoring coronary flow and preserve vital myocardium. Diagnosis of CAD in hypertensive patients may often be complicated by the concomitant presence of electrocardiographic abnormalities, such as ST-segment depression (at rest or during exercise), which may occur even in the absence of coronary atherosclerosis. Thus, proper identification of CAD may result difficult to perform in the setting of clinical practice, mostly in the presence of left ventricular hypertrophy. In this review, we will briefly discuss diagnostic protocols and pharmacological strategies that can be applied in a setting of hypertension emergency with acute cardiac organ damage in the light of the currently available evidence and recommendations from recent guidelines on hypertension management and control.

Authors+Show Affiliations

Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy. giuliano.tocci@uniroma1.it. IRCCS Neuromed, Pozzilli, IS, Italy. giuliano.tocci@uniroma1.it.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.IRCCS Neuromed, Pozzilli, IS, Italy.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy. IRCCS Neuromed, Pozzilli, IS, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30066227

Citation

Tocci, Giuliano, et al. "Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome." High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension, vol. 25, no. 3, 2018, pp. 253-259.
Tocci G, Figliuzzi I, Presta V, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome. High Blood Press Cardiovasc Prev. 2018;25(3):253-259.
Tocci, G., Figliuzzi, I., Presta, V., Miceli, F., Citoni, B., Coluccia, R., Musumeci, M. B., Ferrucci, A., & Volpe, M. (2018). Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome. High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension, 25(3), 253-259. https://doi.org/10.1007/s40292-018-0275-y
Tocci G, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome. High Blood Press Cardiovasc Prev. 2018;25(3):253-259. PubMed PMID: 30066227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome. AU - Tocci,Giuliano, AU - Figliuzzi,Ilaria, AU - Presta,Vivianne, AU - Miceli,Francesca, AU - Citoni,Barbara, AU - Coluccia,Roberta, AU - Musumeci,Maria Beatrice, AU - Ferrucci,Andrea, AU - Volpe,Massimo, Y1 - 2018/07/31/ PY - 2018/06/15/received PY - 2018/07/24/accepted PY - 2018/8/2/pubmed PY - 2018/12/12/medline PY - 2018/8/2/entrez KW - Acute coronary syndrome KW - Blood pressure KW - Essential hypertension KW - Hypertension emergency KW - Hypertension urgency KW - Myocardial infarction KW - Unstable angina SP - 253 EP - 259 JF - High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension JO - High Blood Press Cardiovasc Prev VL - 25 IS - 3 N2 - Uncontrolled hypertension is one of the most common determinant for the persistently high burden of cardiovascular (CV) disease, mostly including coronary artery disease (CAD) and hospital admissions due to acute coronary events. Markedly high blood pressure (BP) levels are also frequently observed during the acute phase of coronary syndromes (both ST-segment and non-ST-segment elevation myocardial infarction and unstable angina). In particular, a sustained raise of BP levels above 180/110 mmHg associated with acute cardiac organ damage, i.e. myocardial ischemia, represents a condition of hypertension emergency and requires rapid hospital admission, prompt pharmacological therapies and non-pharmacological interventions, aimed at restoring coronary flow and preserve vital myocardium. Diagnosis of CAD in hypertensive patients may often be complicated by the concomitant presence of electrocardiographic abnormalities, such as ST-segment depression (at rest or during exercise), which may occur even in the absence of coronary atherosclerosis. Thus, proper identification of CAD may result difficult to perform in the setting of clinical practice, mostly in the presence of left ventricular hypertrophy. In this review, we will briefly discuss diagnostic protocols and pharmacological strategies that can be applied in a setting of hypertension emergency with acute cardiac organ damage in the light of the currently available evidence and recommendations from recent guidelines on hypertension management and control. SN - 1179-1985 UR - https://www.unboundmedicine.com/medline/citation/30066227/Therapeutic_Approach_to_Hypertension_Urgencies_and_Emergencies_During_Acute_Coronary_Syndrome_ DB - PRIME DP - Unbound Medicine ER -