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Cardiac Complications of Hypertensive Emergency: Classification, Diagnosis and Management Challenges

Mohammed A Talle1,2, Ellen Ngarande1, Anton F Doubell1

  • 1Department of Medicine, Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa.

Journal of Cardiovascular Development and Disease
|August 25, 2022
PubMed

Insights

Hypertensive emergencies cause acute organ damage despite improved mortality. Cardiac troponin testing is underutilized, leading to missed diagnoses of myocardial injury in these critical patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Hypertensive emergency, a surge in blood pressure, causes acute organ damage, particularly cardiovascular complications like heart failure and myocardial infarction.
  • While mortality has decreased, the incidence of acute hypertension-mediated organ damage remains a concern.
  • Elevated cardiac troponin is a key outcome predictor, yet myocardial injury is underdiagnosed in hypertensive emergencies.

Purpose of the Study:

  • To review the epidemiology and pathophysiology of hypertensive emergencies.
  • To highlight challenges in evaluating and managing cardiac complications.
  • To propose an algorithm for assessing cardiac acute hypertension-mediated organ damage.

Main Methods:

  • Narrative review of existing literature.
  • Analysis of current guidelines for hypertensive emergencies.
  • Development of a proposed evaluation and classification algorithm for cardiac damage.

Main Results:

  • Hypertensive emergencies frequently lead to cardiovascular damage, with cardiac troponin levels being critical prognostic indicators.
  • Current guidelines may lead to underdiagnosis of myocardial injury by limiting troponin testing to ischemic presentations.
  • A systematic approach is needed to accurately evaluate cardiac involvement.

Conclusions:

  • Despite improved survival, acute organ damage in hypertensive emergencies persists, necessitating better diagnostic strategies.
  • Cardiac troponin assays should be considered more broadly in hypertensive emergencies to detect myocardial injury.
  • A structured algorithm can improve the evaluation and classification of cardiac acute hypertension-mediated organ damage.

Keywords:
cardiac acute hypertension-mediated organ damageclassificationsdiagnosisepidemiologyhypertensive emergencymyocardial injurypathophysiology

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