Hypertensive emergencies: a new clinical approach

Alfonso Lagi,Simone Cencetti 대한고혈압학회 2015 Clinical Hypertension Vol.21 No.16

The expression ‘hypertensive urgencies’ includes many diseases. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs. The aim of the review was to define the idea of the ‘acute hypertension’ as a new concept, different from ‘chronic hypertension’. Acute hypertension might be related to ‘organ damage’ because it is the cause, the consequence or an effect of the acute stress. We compounded a narrative review which has included analyses of 373 articles. The structure of the search strategy included a literature search of PubMed, MEDLINE, Cochrane Library and Google Scholar databases. We applied the following inclusion criteria: prospective double-blind randomised controlled trials, experimental animal work studies, case–control studies and recruiting patients representative of the general sick population. In this review, the diseases included in the term ‘hypertensive emergencies’ share ‘acute’ hypertension. This is a new idea that emphasises the suddenly increased arterial pressure, irrespective of the initial arterial pressure and independent of the goals of hypertension control. The ‘hypertensive emergencies’ have been grouped together in three subsets: (1) diseases that result from acute hypertension that is caused by faulty regulation of the peripheral circulation (acute primary hypertension), (2) diseases that produce hypertension (acute secondary hypertension) and 3) diseases that have hypertension as an effect of the acute stress caused by the principle disease (acute associated hypertension). This review highlights a novel idea: acute hypertension is a common sign of different diseases characterised by the sudden surge of arterial pressure, so overwhelming the difference between hypertensive emergencies and urgencies. The judgment of acute hypertension is independent of the initial arterial pressure, normotension or hypertension and is linked with the transient failure of the baroreflex. Hypertensive emergencies are grouped together because all of these diseases require prompt therapy to prevent the negative outcomes of acute hypertension

악성고혈압 환자에서 황반 하 맥락막 두께 변화

김지원,김윤택,Ji Won Kim,Yun Taek Kim 대한안과학회 2014 대한안과학회지 Vol.55 No.6

Purpose: To evaluate changes in subfoveal choroidal thickness in patients with malignant hypertension. Methods: A total of 12 eyes of six malignant hypertension patients were included in the present study. Intraocular pressure, blood pressure (systolic and diastolic), and choroidal thickness were measured before and after blood pressure control. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). The changes in choroidal extravascular density of the EDI-OCT image after blood pressure control were evaluated by comparing brightness values obtained with Adobe Photoshop software. Results: The subfoveal choroidal thickness (SFCT) of malignant hypertension patients was 412.63 ± 66.55 μm (mean ± SD), which was thicker than in normal patients. After blood pressure control, SFCT decreased significantly to 356.96 ± 59.08 μm (mean ± SD) (<em>p</em> = 0.002). The choroidal extravascular density of the EDI-OCT image decreased after blood pressure control (<em>p</em> = 0.002), and the mean change was 17.21 ± 7.56. Conclusions: The choroid is thickened in patients with malignant hypertension, and its thickness decreases after blood pressure control. This suggests that changes in blood pressure may affect choroidal thickness. J Korean Ophthalmol Soc 2014;55(6):840-846

Malignant Hypertension with an Unusual Presentation Mimicking the Immune Mediated Pulmonary Renal Syndrome

박훈석,최범순,홍유아,정병하,김형욱,박철휘,양철우,진동찬,김용수 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.6

A 27-year-old man presented at the emergency room with hemoptysis. His blood pressure was 180/100 mm Hg, and he had no history of hypertension. Chest radiographs showed bilateral infiltration, suggestive of alveolar hemorrhage. His laboratory data were consistent with acute kidney injury. His serum creatinine level increased abruptly; therefore, renal biopsy was performed. Steroid pulse therapy was administered because of a strong suspicion of immune-mediated pulmonary renal syndrome. Renal biopsy showed proliferative endarteritis, fibrinoid necrosis, and intraluminal thrombi in the vessels without crescent formation or necrotizing lesions. Steroid pulse therapy rapidly tapered and stopped. His serum creatinine level gradually decreased with strict blood pressure control. Ten months after discharge, his blood pressure was approximately 120/80 mm Hg with a serum creatinine level of 1.98 mg/dL. Pulmonary renal syndrome is generally caused by an immune-mediated mechanism. However, malignant hypertension accompanying renal insufficiency and heart dysfunction causing end-organ damage can create a pulmonary hemorrhage, similar to pulmonary renal syndrome caused by an immune-mediated mechanism. The present case shows that hypertension, a common disease, can possibly cause pulmonary renal syndrome, a rare condition.

악성고혈압의 바이오피드백 단기 혈압강하 치험1례

오승윤,김연주,김락형,박수정 대한한의학회 2024 대한한의학회지 Vol.45 No.1

Objectives: The purpose of this study was to report the short-term blood pressure-lowering effects observed in a patient with malignant hypertension through slow breathing maneuver with heart rate variability(HRV) biofeedback. Methods: Biofeedback sessions, totaling 13, each lasting 10 minutes, were administered. Blood pressure was measured pre and post-treatment, as well as thrice daily at 10 am, 4 pm, and 8 pm. Systolic blood pressure(SBP), diastolic blood pressure(DBP), and pulse rate were recorded for comparative analysis. Results: Before biofeedback, the average SBP, DBP, and pulse rate were 227.2±18.3, 135.2±11.0, and 104.4±5.3, respectively. Immediately post-biofeedback, these values changed to 213.7±15.2, 126.9±8.5, and 99.2±3.6. However, sustained long-term blood pressure reduction was not observed. Conclusions: The findings suggest that biofeedback therapy induces a short-term reduction in blood pressure in cases of malignant hypertension, potentially associated with autonomic nervous system regulation. Integrating biofeedback with other Korean medicine treatments, such as acupuncture or moxibustion, may offer a comprehensive approach for managing malignant hypertension.

엽사이 신장동맥 협착으로 발생된 만성 신기능 부전 환자에서의 고혈압 응급증

전우성,김수홍,김종빈,조성환,김오길,고지호 고신대학교의과대학 2006 고신대학교 의과대학 학술지 Vol.21 No.2

We experienced a 68-year-old male patient who visited our clinic because of sudden onset occipital headache, chest pain and poorly controlled hypertension. We diagnosed as a hypertensive emergencies in chronic renal insuffiency and perform coronary angiogram and renal angiogram. There was a significant stenosis at the interlobar artery of right kidney, and successful percutaneous transluminal renal angioplasty (PTRA) was performed.

만성신부전증에서 진단된 일측 신동맥 협착 및 반대측 신장의 국소분절사구체경화증

홍성진 ( Sung Jin Hong ),김동기 ( Dong Ki Kim ),구철룡 ( Cheol Ryong Ku ),이한성 ( Han Sung Lee ),최규헌 ( Kyu Hun Choi ),이호영 ( Ho Yung Lee ),한대석 ( Dae Suk Han ),정현주 ( Hyeon Joo Jeong ),김범석 ( Beom Seok Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2

We report a case of focal segmental glomerulosclerosis (FSGS) with chronic renal failure in a patient with unilateral renal artery stenosis. A 38-year-old woman presented with malignant hypertension, massive proteinuria and renal insufficiency. MR angiography showed proximal stenosis of the right renal artery and biopsy of the left kidney revealed focal segmental glomerulosclerosis. The patient responded favorably to the angiotensin Ⅱ receptor antagonist, as the blood pressure and urinary protein decreased. This case showed that FSGS is a pathophysiologic mechanism of renal injury in uncontrolled renovascular hypertension.

한국인 악성 고혈압의 임상적 고찰

오동진(Dong Jin Oh),이준승(Jun Seung Lee),박지현(Jee Hyun Park),곽귀철(Gue Chul Gawk),강응택(Eung Taek Kang),유석희(Suk Hee Yu) 대한내과학회 1995 대한내과학회지 Vol.48 No.6

Objectives: Prior to the development of effective antihypertensive regimen and renal replacement therapy, malignant hypertension regarded as a bad prognostic disease. Sine 1960 with the early detection of hypertension and the introduction of new potent antihypertensive regimens and renal replacement therapy, there were several reports of etiologic changes and improving survival rates. However there has been a few reports concerning malignant hypertension in 1990s and never reported in Korea so far. The purpose of this study is to know the cause, clinical feature and survival rate of malignant hypertension in Korean, Method: The definition of malignant hypertension is characterized as grade III or IV hypertensive retinopathy according to Keith-Wagener-Barkers classification. we reviewed 107 patients with malignant hypertension who visited our department between 1988 and 1993 retrospectively. Results: The mean age of essential hypertension was 56years, renal lesion 37years, renovascular lesion 45years, and that of unknown cause was 41years, The mean blood pressure of essential hypertension was 209mmHg/128mmHg, renal lesion 194mmHg/120mmHg, renovascular lesion 210mmHg/130mmHg, and that of unknown cause was 183mmHg/125mmHg. The initial serum creatinine of essential hypertension was 2.45±2.51mg/dl, renal lesion 8.10±7.56mg/dl, renovascular lesion 1.95±0.35mg/dl, and that of unknown cause was 15.44±10.24mg/dl. Essential hypertension was diagnosed in 56 cases (53%), secondary hypertension in 40 cases (37%) and unknown cause in 11 cases(10%). The One year patient was 92% and 5 year survival survival 51%. The 5 year patient survival of essential hypertension was 85% and that of secondary hypertension was 86%. The 5year patient survival was 92% in the group of initial serum creatinine <3mg/dl, but 81% in the group of inital serum creatinine >3mg/dl. Ten patients died. Of these, three patients died of cerebrovascular accident, three patients died of hyperkalemia. Other causes of death were pulmonary edema, hepatic encephalopathy, lung cancer, and socioeconomic factor. Conclusion: the main cause of malignant hypertension in Korea was primary hypertension and survival rates were similar to recent other reports.

Case Report : A Case of Systemic Lupus Erythematosus Presenting as Malignant Hypertension with Hypertensive Retinopathy

( Jung Yoon Choe ),( Sung Hoon Park ),( Ji Young Kim ),( Hyun Young Jung ),( Seong Kyu Kim ) 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.3

The variability of cardiovascular abnormalities is one of the characteristics of systemic lupus erythematosus (SLE). Among the cardiovascular manifestations, hypertension is reported in 14% to 58.1% of patients in diverse ethnic populations, and remains a clinically important issue due to its close relationship with early mortality in patients with SLE. The development of hypertension in patients with SLE has been associated with advanced lupus-related renal disease and the medications used for the treatment of lupus. Malignant hypertension is a serious complication of hypertension; it rarely occurs in patients with SLE. However, it can occur in patients with other complicated medical conditions such as the antiphospholipid antibody syndrome (APS) or cardiac tamponade. Here, we report the case of a patient with SLE and malignant hypertension with hypertensive retinopathy that initially presented without clinical evidence of APS or hypertensive nephropathy. (Korean J Intern Med 2010;25:341-344)

Malignant Hypertension with Pulmonary Alveolar Hemorrhage Needing Dialysis

Younghun Kim,Ki Tae Bang,Jong Ho Shin,Ju Ri Kim,Joo Heon Kim,Jin Uk Jeong 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.2

Predominant Hypertensive Brainstem Encephalopathy with Supratentorial Involvement: Case Report and Literature Review

김지희,박성태,임현경,김성태,차지훈 대한영상의학회 2014 대한영상의학회지 Vol.71 No.6

Hypertensive encephalopathy typically presents with bilateral parietooccipital vasogenic edema. Brainstem and cerebellar edema are uncommon in association with typical supratentorial changes. We experienced three cases of atypical hypertensive encephalopathy involving brainstem and cerebellum as well as cerebral white matter, which showed characteristic alternating linear bright and low signals in the pons, the so-called “stripe sign”. We report these cases here with a brief literature review.