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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

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Modern Management of Hypertensive Emergencies

Gian Paolo Rossi1,2, Giacomo Rossitto3,4, Chiarastella Maifredini3

  • 1Department of Medicine-DIMED, University of Padua, Padua, Italy. gianpaolo.rossi@unipd.it.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension
|November 23, 2021
PubMed

Insights

This study proposes a new algorithm for managing hypertensive emergencies, focusing on symptoms and evidence. It recommends abandoning outdated terms like

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Management

Background:

  • Acute increases in blood pressure are frequent emergency department presentations, posing management challenges.
  • Traditional terms like 'hypertensive crises' and 'hypertensive urgencies' are deemed misleading by recent European Society of Cardiology guidelines.
  • Current treatment guidelines for these conditions lack robust evidence due to a scarcity of randomized clinical trials.

Purpose of the Study:

  • To introduce a novel, streamlined algorithm for the assessment and management of patients with hypertensive emergencies.
  • To provide a symptoms- and evidence-based approach to clinical decision-making in hypertensive emergencies.
  • To promote the adoption of accurate terminology, focusing solely on 'hypertensive emergencies'.

Main Methods:

  • Systematic review of existing studies, with quality grading using AHA class of recommendation and level of evidence.
  • Development of a novel algorithm based on improved understanding of pathophysiology.
  • Utilizing the Brain, Arteries, Retina, Kidney, and/or Heart (BARKH) strategy for identification of hypertensive emergencies.

Main Results:

  • A novel algorithm for hypertensive emergencies is presented.
  • The BARKH strategy facilitates identification of hypertensive emergencies.
  • The proposed algorithm integrates pathophysiology insights and evidence grading.

Conclusions:

  • A new evidence-based algorithm offers a streamlined approach to hypertensive emergencies.
  • Accurate identification and management are crucial for patients presenting with elevated blood pressure.
  • The BARKH strategy aids in the precise diagnosis of hypertensive emergencies.

Keywords:
High blood pressureHypertensive emergenciesOrgan damageTreatment

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