RESUMEN
Blood pressure variation (BPV) is a known risk factor for unfavorable stroke outcomes. However, little is known about the association between BPV and short-term outcomes in stroke patients after receiving thrombolytic therapy, namely, recombinant tissue plasminogen activator (rt-PA). We conducted a cross-sectional study in the specialized stroke unit of a tertiary-level hospital. Stroke patients who were eligible for rt-PA were enrolled. Blood pressure (BP) was measured every 4 h for 24 h. The SD, coefficient of variation (CV) and successive variation (SV) of both SBP and DBP were calculated. The final outcomes were symptomatic intracerebral hemorrhage (sICH) or in-hospital death from neurologic complications. A total of 278 patients (49.6% men) were enrolled, mean age was 65 years. The final outcomes were reported in 33 patients (11.9%). All systolic and diastolic BPV profiles were associated with the final outcome. Odds ratios (95% confident interval) were SD, 1.07 (1.02-1.13); CV, 1.10 (1.03-1.18) and SV, 1.05 (1.01-1.09) for SBP, and SD, 1.10 (1.02-1.19); CV, 1.08 (1.01-1.16) and SV, 1.09 (1.02-1.15) for DBP. After adjustment for conventional risk factors, SD, CV and SV of SBP, and SD and SV of DBP were still significantly associated with the final outcome. In conclusion, in-hospital systolic (SD, SV and CV) and diastolic (SV, SD) BPV profiles were associated with death and sICH in stroke patients after rt-PA therapy.
Asunto(s)
Accidente Cerebrovascular , Activador de Tejido Plasminógeno , Anciano , Presión Sanguínea/fisiología , Hemorragia Cerebral , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Factores de Riesgo , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversosRESUMEN
Hypertensive emergency care is a challenge in clinical practices due to vital organ complications that may lead to unfavorable outcomes if left untreated. The objectives of this study were to determine the prevalence, clinical characters, treatment, and outcomes of hypertensive emergency patients. A retrospective cohort study was conducted at a university hospital in Northeast Thailand from January 2016 to December 2019. Hypertensive crises patients were consecutively registered to the Hypertension Registry Program. There were 263 674 patients who were admitted to the ER, 60,755 of whom had BP ≥ 140/90 mm Hg and 1,342 of whom were diagnosed with a hypertensive emergency (127 per 100 000 patient-year). The mean age was 66 years old, and 52.1% of the registered patients were men. The most common target organ damage was caused by stroke (49.8%), followed by acute heart failure (19.3%), and then by acute coronary syndrome (6.5%). Intravenous antihypertensive medication was given in 42.1% of the patients, and 80% were admitted to the hospital. The in-hospital mortality rate was 1.6%. In conclusion, hypertensive emergencies were not uncommon among the emergency patients. Strokes caused the most common target organ damage. Although there was a high hospital admission rate, the mortality rate was low.
Asunto(s)
Hipertensión , Anciano , Antihipertensivos/uso terapéutico , Urgencias Médicas , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Sistema de Registros , Estudios Retrospectivos , Tailandia , Resultado del TratamientoRESUMEN
Hypertensive urgency (HT urgency) is an alarming sign of uncontrolled hypertension. It is aggravated by nonadherence to medication, as well as psychosocial stress. Mindfulness is beneficial for reducing stress, while deep and slow breathing is effective for lowering blood pressure (BP). In our study, we aimed to assess BP and heart rate effects in HT urgency patients practicing pursed-lip breathing and number counting (PLB with NC)-a practice that promotes mindfulness with deep/slow breathing patterns. In a randomized controlled trial, 110 patients were equally allocated to intervention and control groups. The intervention group was trained and encouraged to do PLB with NC during their emergency room admission, while the control group received conventional medical care. The mean systolic BP (SBP), diastolic BP (DBP), and HR of the intervention group in the 3rd hour were significantly lower than the baseline values at -28.2 mm Hg (95%CI;-23.5 to -32.4), -17.1 mm Hg (95%CI;-14.2 to -20.0), and -4.9 beats per minute (bpm) (95%CI;-4.0 to -5.8), respectively. In the control group, both the mean SBP and DBP were also significantly lower in the 3rd hour. However, HR reduction was inconclusive. When the two groups were compared, a greater degree of reduction was found in the intervention group for SBP (9.80 mm Hg, 95%CI; 4.10 to 15.50), DBP (7.69 mm Hg, 95%CI; 3.61 to 11.77), and HR (3.85 bpm, 95%CI; 1.99 to 5.72). In conclusion, PLB with NC was effective for lowering BP and HR. It might be used as a complementary treatment for HT urgency patients.
Asunto(s)
Hipertensión , Labio , Antihipertensivos/farmacología , Antihipertensivos/uso terapéutico , Presión Sanguínea , Frecuencia Cardíaca , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológicoRESUMEN
Hypertension (HT) is a prominent cardiovascular risk factor. Although there are various pharmacological treatment choices for this condition, many patients fail to adhere to them, making non-pharmacological options attractive alternatives. Foot reflexology has been proven to decrease blood pressure (BP), but data are limited in patients with stage-2 HT. We conducted a randomized clinical trial to examine the effectiveness of foot reflexology in reducing BP and heart rate (HR). Stage-2 HT patients were enrolled and randomized into the intervention and the control groups (n = 47, each), the former of which underwent foot reflexology during a follow-up visit. Office BP and HR were measured before and at 15 and 30 min after the procedure in the intervention group and after resting in the control group. In the intervention group, systolic BP (SBP), diastolic BP (DBP), and HR at 15 min were significantly lower than at baseline: -3.29 mm Hg (95%CI; -5.64 to -0.93), -1.71 mm Hg (95%CI; -3.11 to -0.32), and -1.71 beats per min (bpm; 95%CI; -2.88 to -0.54), respectively. Similar trends were also observed at 30 min. However, when compared with the control group, only the reduction in HR was significant (-4.96 bpm; 95%CI, -9.63 to -0.28). We conclude that foot reflexology was effective in reducing HR in stage-2 HT patients and partially effective in reducing BP.
Asunto(s)
Hipertensión , Manipulaciones Musculoesqueléticas , Presión Sanguínea , Frecuencia Cardíaca , Humanos , Hipertensión/tratamiento farmacológicoRESUMEN
INTRODUCTION: Hypertensive (HT) urgency is a common presentation in emergency room (ER). Although the practice guideline recommends against rapid blood pressure (BP) reduction, in medical practice, physicians usually attempt to timely reduce BP in order to avoid target organ damage. However, there is limited data in Asians. This study was designed to fill the gap of knowledge by using the dataset of the HT crises patients at a tertiary care center. AIM: To determine the characteristics, treatments, and outcomes of HT urgency patients during ER visit and at 2-week follow-up. METHODS: A retrospective cohort study conducted at a university hospital in northeast Thailand from January 2012 to June 2017. Hypertensive crises patients were consecutively enrolled. RESULTS: Of the 221,287 patients who admitted to the ER, prevalence rates of HT urgency and HT emergency were 48.5 and 15.5 per 100,000 patients-year. In HT urgency cases, the average initial and discharge SBP/DBP were 200/110 and 163/92 mmHg, respectively. Oral anti-HT medications were most frequently prescribed (90.5%). At a 2-week follow-up, 24.6% of patients had BP < 140/90 mmHg. The SBP at ER discharge was significantly lower in the patients with follow-up BP < 140/90 compared to those with BP > 140/90 mmHg (158.8 ± 16.9 vs. 164.2 ± 16.6 mmHg, P < 0.01). CONCLUSIONS: Hypertensive urgency was common among patients admitted to the ER. Oral anti-HT medication effectively reduced BP. One in five patients had BP < 140/90 mmHg at a 2-week follow-up and systolic BP at discharge might be an important factor in predicting better BP control.