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

Select a language for the TTS:
UK English Female
UK English Male
US English Female
US English Male
Australian Female
Australian Male
Language selected: (auto detect) - EN

Nature

Play all audios:

You have full access to this article via your institution. Download PDF TO THE EDITOR: 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). 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. Severe epistaxis is properly considered a HTN-E in JSH 2019 [10], but the vast majority of patients with epistaxis do not require intensive care unit admission or

intravenous antihypertensive drugs. Hence, JSH 2019 reasonably considers nonsevere epistaxis a hypertensive urgency (HTN-U). Therefore, it is correct to list epistaxis as a HTN-U _despite it

being an acute HMOD_ because it is not a _life-threatening situation_ [8]. A HTN-E is almost always defined as an acute HMOD, without a direct statement about a high degree of risk. This

has led to poor consistency, for example, in the assessment of epistaxis. Epistaxis is an acute HMOD, but it is not classified as a HTN-E; in contrast, it is listed as a HTN-U. The reason is

that epistaxis is not a life-threatening condition. This reason is not provided in any available guidelines. In conclusion, our suggestion is to add “_resulting in a life-threatening

situation_” in the future definitions of HTN-E. This addition can address the inconsistency related to epistaxis and can help physicians when in doubt regarding how to classify a case of

acute HTN. REFERENCES * 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 * 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 * 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 * 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 * 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. * 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 * 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 * 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 * 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 * 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 * 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 Download references ACKNOWLEDGEMENTS This work has been supported by the Serbian Ministry of Education and

Science, Belgrade, Serbia (Grant No. 175092 and III41018). AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia Goran

Koracevic * Faculty of Medicine, University of Nis, Nis, Serbia Goran Koracevic, Dragan Djordjevic & Maja Koracevic * Clinic for Internal Diseases Inter Medica, Nis, Serbia Dragan Lovic

* Singidunum University, School of Medicine, Nis, Serbia Dragan Lovic * Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia Milovan Stojanovic & Dragan Djordjevic *

Innovation Center, University of Nis, Nis, Serbia Maja Koracevic Authors * Goran Koracevic View author publications You can also search for this author inPubMed Google Scholar * Dragan Lovic

View author publications You can also search for this author inPubMed Google Scholar * Milovan Stojanovic View author publications You can also search for this author inPubMed Google

Scholar * Dragan Djordjevic View author publications You can also search for this author inPubMed Google Scholar * Maja Koracevic View author publications You can also search for this author

inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Milovan Stojanovic. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare that they have no conflicts of interest.

ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Reprints

and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE 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 Download citation * Received: 23 May 2020 * Revised: 29 May 2020 *

Accepted: 07 June 2020 * Published: 29 June 2020 * Issue Date: December 2020 * DOI: https://doi.org/10.1038/s41440-020-0501-6 SHARE THIS ARTICLE Anyone you share the following link with will

be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt

content-sharing initiative