The Experts below are selected from a list of 3066 Experts worldwide ranked by ideXlab platform
Massoud A. Leesar - One of the best experts on this subject based on the ideXlab platform.
-
ischemic evaluation in patients presenting with Hypertensive Emergency urgency and acute systolic heart failure is coronary angiography required for all
Cardiovascular Revascularization Medicine, 2019Co-Authors: Jared W Davis, Muhannad Almubarak, Samuel K Mcelwee, Amrita Mukherjee, Massoud A. LeesarAbstract:Abstract Background Patients presenting with Hypertensive urgency / Emergency (HUE) often have systolic heart failure(SHF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (Obs-CAD). We performed a retrospective study to investigate predictors of ObsCAD in this population. Methods Patients who underwent angiography to investigate SHF and had hospital admission(s) for HUE in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. A risk score was formulated based on multivariable logistic regression analysis. Results 205 patients [age 58.9 ± 14.4 years; 62.4% male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients ( n = 68) had obs-CAD. Patients with obs-CAD were older, diabetic, more likely to have a history of stroke, echocardiographic regional wall motion abnormalities (RWMA) while African Americans were less likely to have obs-CAD. On multivariable analysis, only non-African American race (OR: 2.18; CI: 1.08–4.4) and RWMA (OR: 5.62; CI: 2.47–12.81) remained significant predictors of obs-CAD. A risk score (RANDS) from 0 to 9 was formulated which had a c-statistic of 0.75 with a sensitivity and specificity of 84% and 53% for predicting obsCAD respectively. Conclusion Our results suggest that only a minority of patients with HUE and SHF have obs-CAD. A simple risk score may be used to stratify this population and lower risk individuals may be screened with non-invasive testing instead of invasive catheterization. These results should be validated in large registry populations.
-
abstract p136 ischemic evaluation in patients with Hypertensive Emergency urgency and acute systolic heart failure is coronary angiography required for all
Hypertension, 2017Co-Authors: Jared W Davis, Muhannad Almubarak, Samuel K Mcelwee, Firas Alsolaiman, Mark Sasse, Amrita Mukherjee, Massoud A. LeesarAbstract:Aim: Patients presenting with Hypertensive urgency / Emergency (HU/E) often have systolic heart failure(S-HF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (O-CAD). We performed a retrospective study to investigate predictors of O-CAD in this population. Methods: Consecutive patients who underwent angiography to investigate S-HF and had hospital admissions for HU/E in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. Statistical analysis was performed using SAS 9.4 software. Results: 205 patients [age 58.9 ± 14.4 years; 62.4 % male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients (n=68) had O-CAD. Age > 60 years (Odds Ratio: 2.3; 95% Confidence intervals: 1.3-4.3) , Diabetes (OR: 2.1; 95% CI: 1.2-3.8), history of stroke (OR: 2.7; 95% CI: 1.1-7.0) and presence of regional wall motion abnormalities (RWMA; OR: 7.4; 95% CI: 3.4-16.1) and abnormal perfusion study (OR: 7.6; 95% CI: 1.5-39.6) were significantly associated with O-CAD while African American (AA) race was a protective factor (OR: 0.4; 95% CI: 0.2-0.8). ROC curves constructed using an age cut off of 60 years along with non AA race, diabetes and RWMA yielded a good fit with a c statistic of 0.75. Conclusions: Our results suggest that only a minority of patients with HU/E and S-HF have obstructive CAD. It may be possible to stratify patients using demographic and non-invasive tests to direct only those with high likelihood of O-CAD for coronary angiography. These results should be validated in large registry populations.
Dil Tahera - One of the best experts on this subject based on the ideXlab platform.
-
Hypertensive urgency and Emergency in alcohol withdrawal a literature review
The Primary Care Companion To The Journal of Clinical Psychiatry, 2019Co-Authors: Ermal Bojdani, Tina Zhang, Nida Z Naqvi, Anderson Chen, Dil TaheraAbstract:Objective: To help clinicians recognize that hypertension, Hypertensive urgency, and Hypertensive Emergency can arise in patients detoxifying from alcohol. Diagnostic and treatment implications are reviewed to help clinicians manage blood pressure in these situations. Data Sources: PubMed was searched with no restrictions on publication date or study type in June 2019 using the terms (alcohol withdrawal) AND hypertension. Study Selection: Of 531 studies retrieved, all were reviewed, and articles older than 20 years were excluded. Of the remaining 158 articles, all were reviewed by full-text reading, and 17 were selected based on relevance. Seven UpToDate articles and 2 older papers were also included for relevance. Data Extraction: Various other searches were also performed; however, no relevant hits resulted when the following terms were entered: (Hypertensive urgency/Emergency) AND alcohol withdrawal OR detoxification; (Hypertensive urgency/Emergency) AND (alcohol withdrawal OR detoxification) AND treatment-resistant hypertension. Results: Hypertension is typically self-limited in alcohol withdrawal syndrome; however, treatment is important to prevent Hypertensive urgency or Emergency. There is a paucity of data on how best to manage hypertension in patients withdrawing from alcohol, with treatment often individualized. Patients with underlying treatment-resistant hypertension may have more difficult-to-control blood pressure, especially in the first 24 hours of withdrawal. Conclusions: Multiple medications may be used to treat hypertension in the setting of alcohol withdrawal, with selection based on side effect profile and the patient's other comorbidities. In patients for whom there is concern for Hypertensive urgency versus Emergency, full medical evaluation is indicated to identify any potential end-organ damage.
-
Hypertensive urgency and Emergency in alcohol withdrawal a literature review
The Primary Care Companion To The Journal of Clinical Psychiatry, 2019Co-Authors: Ermal Bojdani, Tina Zhang, Nida Z Naqvi, Anderson Chen, Dil TaheraAbstract:Objective: To help clinicians recognize that hypertension, Hypertensive urgency, and Hypertensive Emergency can arise in patients detoxifying from alcohol. Diagnostic and treatment implications are reviewed to help clinicians manage blood pressure in these situations. Data Sources: PubMed was searched with no restrictions on publication date or study type in June 2019 using the terms (alcohol withdrawal) AND hypertension. Study Selection: Of 531 studies retrieved, all were reviewed, and articles older than 20 years were excluded. Of the remaining 158 articles, all were reviewed by full-text reading, and 17 were selected based on relevance. Seven UpToDate articles and 2 older papers were also included for relevance. Data Extraction: Various other searches were also performed; however, no relevant hits resulted when the following terms were entered: (Hypertensive urgency/Emergency) AND alcohol withdrawal OR detoxification; (Hypertensive urgency/Emergency) AND (alcohol withdrawal OR detoxification) AND treatment-resistant hypertension. Results: Hypertension is typically self-limited in alcohol withdrawal syndrome; however, treatment is important to prevent Hypertensive urgency or Emergency. There is a paucity of data on how best to manage hypertension in patients withdrawing from alcohol, with treatment often individualized. Patients with underlying treatment-resistant hypertension may have more difficult-to-control blood pressure, especially in the first 24 hours of withdrawal. Conclusions: Multiple medications may be used to treat hypertension in the setting of alcohol withdrawal, with selection based on side effect profile and the patient's other comorbidities. In patients for whom there is concern for Hypertensive urgency versus Emergency, full medical evaluation is indicated to identify any potential end-organ damage.
Jared W Davis - One of the best experts on this subject based on the ideXlab platform.
-
ischemic evaluation in patients presenting with Hypertensive Emergency urgency and acute systolic heart failure is coronary angiography required for all
Cardiovascular Revascularization Medicine, 2019Co-Authors: Jared W Davis, Muhannad Almubarak, Samuel K Mcelwee, Amrita Mukherjee, Massoud A. LeesarAbstract:Abstract Background Patients presenting with Hypertensive urgency / Emergency (HUE) often have systolic heart failure(SHF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (Obs-CAD). We performed a retrospective study to investigate predictors of ObsCAD in this population. Methods Patients who underwent angiography to investigate SHF and had hospital admission(s) for HUE in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. A risk score was formulated based on multivariable logistic regression analysis. Results 205 patients [age 58.9 ± 14.4 years; 62.4% male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients ( n = 68) had obs-CAD. Patients with obs-CAD were older, diabetic, more likely to have a history of stroke, echocardiographic regional wall motion abnormalities (RWMA) while African Americans were less likely to have obs-CAD. On multivariable analysis, only non-African American race (OR: 2.18; CI: 1.08–4.4) and RWMA (OR: 5.62; CI: 2.47–12.81) remained significant predictors of obs-CAD. A risk score (RANDS) from 0 to 9 was formulated which had a c-statistic of 0.75 with a sensitivity and specificity of 84% and 53% for predicting obsCAD respectively. Conclusion Our results suggest that only a minority of patients with HUE and SHF have obs-CAD. A simple risk score may be used to stratify this population and lower risk individuals may be screened with non-invasive testing instead of invasive catheterization. These results should be validated in large registry populations.
-
abstract p136 ischemic evaluation in patients with Hypertensive Emergency urgency and acute systolic heart failure is coronary angiography required for all
Hypertension, 2017Co-Authors: Jared W Davis, Muhannad Almubarak, Samuel K Mcelwee, Firas Alsolaiman, Mark Sasse, Amrita Mukherjee, Massoud A. LeesarAbstract:Aim: Patients presenting with Hypertensive urgency / Emergency (HU/E) often have systolic heart failure(S-HF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (O-CAD). We performed a retrospective study to investigate predictors of O-CAD in this population. Methods: Consecutive patients who underwent angiography to investigate S-HF and had hospital admissions for HU/E in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. Statistical analysis was performed using SAS 9.4 software. Results: 205 patients [age 58.9 ± 14.4 years; 62.4 % male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients (n=68) had O-CAD. Age > 60 years (Odds Ratio: 2.3; 95% Confidence intervals: 1.3-4.3) , Diabetes (OR: 2.1; 95% CI: 1.2-3.8), history of stroke (OR: 2.7; 95% CI: 1.1-7.0) and presence of regional wall motion abnormalities (RWMA; OR: 7.4; 95% CI: 3.4-16.1) and abnormal perfusion study (OR: 7.6; 95% CI: 1.5-39.6) were significantly associated with O-CAD while African American (AA) race was a protective factor (OR: 0.4; 95% CI: 0.2-0.8). ROC curves constructed using an age cut off of 60 years along with non AA race, diabetes and RWMA yielded a good fit with a c statistic of 0.75. Conclusions: Our results suggest that only a minority of patients with HU/E and S-HF have obstructive CAD. It may be possible to stratify patients using demographic and non-invasive tests to direct only those with high likelihood of O-CAD for coronary angiography. These results should be validated in large registry populations.
Michael S. Runyon - One of the best experts on this subject based on the ideXlab platform.
-
profile of patients with Hypertensive urgency and Emergency presenting to an urban Emergency department of a tertiary referral hospital in tanzania
BMC Cardiovascular Disorders, 2018Co-Authors: Patrick Shao, Hendry R Sawe, Juma A Mfinanga, Michael S. Runyon, Victor Mwafongo, Brittany L MurrayAbstract:Hypertensive crises are clinical syndromes grouped as Hypertensive urgency and Emergency, which occur as complications of untreated or inadequately treated hypertension. Emergency departments across the world are the first points of contact for these patients. There is a paucity of data on patients in Hypertensive crises presenting to Emergency departments in Tanzania. We aimed to describe the profile and outcome of patients with Hypertensive crisis presenting to the Emergency Department of Muhimbili National Hospital in Tanzania. This was a descriptive cohort study of adult patients aged 18 years and above presenting to the Emergency department with Hypertensive urgency or Emergency over a four-month period. Trained researchers used a structured data sheet to document demographic information, clinical presentation, management and outcome. Descriptive statistics with 95% confidence intervals (CIs) are presented as well as comparisons between the groups with Hypertensive urgency vs. Emergency. We screened 8002 patients and enrolled 203 (2.5%). The median age was 55 (interquartile range 45–67 years) and 51.7% were females. Overall 138 (68%) had Hypertensive Emergency; and 65 (32%) had Hypertensive urgency, for an overall rate of 1.7% (95% CI: 1.5 to 2.0%) and 0.81% (95% CI: 0.63 to 1.0%), respectively. Altered mental status was the most common presenting symptom in Hypertensive Emergency [74 (53.6%)]; low Glasgow Coma Scale was the most common physical finding [61 (44.2%)]; and cerebrovascular accident was the most common final diagnosis [63 (31%)]. One hundred twelve patients with Hypertensive Emergency (81.2%) were admitted and three died in the Emergency department, while 24 patients with Hypertensive urgency (36.9%) were admitted and none died in the Emergency department. In-hospital mortality rates for Hypertensive Emergency and urgency were 37 (26.8%) and 2 (3.1%), respectively. In our cohort of adult patients with elevated blood pressure, Hypertensive crisis was associated with substantial morbidity and mortality, with the most vulnerable being those with Hypertensive Emergency. Further research is required to determine the aetiology, pathophysiology and the most appropriate strategies for prevention and management of Hypertensive crisis.
-
Profile of patients with Hypertensive urgency and Emergency presenting to an urban Emergency department of a tertiary referral hospital in Tanzania
BMC, 2018Co-Authors: Patrick J. Shao, Hendry R Sawe, Juma A Mfinanga, Victor Mwafongo, Brittany L Murray, Michael S. RunyonAbstract:Abstract Background Hypertensive crises are clinical syndromes grouped as Hypertensive urgency and Emergency, which occur as complications of untreated or inadequately treated hypertension. Emergency departments across the world are the first points of contact for these patients. There is a paucity of data on patients in Hypertensive crises presenting to Emergency departments in Tanzania. We aimed to describe the profile and outcome of patients with Hypertensive crisis presenting to the Emergency Department of Muhimbili National Hospital in Tanzania. Methods This was a descriptive cohort study of adult patients aged 18 years and above presenting to the Emergency department with Hypertensive urgency or Emergency over a four-month period. Trained researchers used a structured data sheet to document demographic information, clinical presentation, management and outcome. Descriptive statistics with 95% confidence intervals (CIs) are presented as well as comparisons between the groups with Hypertensive urgency vs. Emergency. Results We screened 8002 patients and enrolled 203 (2.5%). The median age was 55 (interquartile range 45–67 years) and 51.7% were females. Overall 138 (68%) had Hypertensive Emergency; and 65 (32%) had Hypertensive urgency, for an overall rate of 1.7% (95% CI: 1.5 to 2.0%) and 0.81% (95% CI: 0.63 to 1.0%), respectively. Altered mental status was the most common presenting symptom in Hypertensive Emergency [74 (53.6%)]; low Glasgow Coma Scale was the most common physical finding [61 (44.2%)]; and cerebrovascular accident was the most common final diagnosis [63 (31%)]. One hundred twelve patients with Hypertensive Emergency (81.2%) were admitted and three died in the Emergency department, while 24 patients with Hypertensive urgency (36.9%) were admitted and none died in the Emergency department. In-hospital mortality rates for Hypertensive Emergency and urgency were 37 (26.8%) and 2 (3.1%), respectively. Conclusion In our cohort of adult patients with elevated blood pressure, Hypertensive crisis was associated with substantial morbidity and mortality, with the most vulnerable being those with Hypertensive Emergency. Further research is required to determine the aetiology, pathophysiology and the most appropriate strategies for prevention and management of Hypertensive crisis
Ermal Bojdani - One of the best experts on this subject based on the ideXlab platform.
-
Hypertensive urgency and Emergency in alcohol withdrawal a literature review
The Primary Care Companion To The Journal of Clinical Psychiatry, 2019Co-Authors: Ermal Bojdani, Tina Zhang, Nida Z Naqvi, Anderson Chen, Dil TaheraAbstract:Objective: To help clinicians recognize that hypertension, Hypertensive urgency, and Hypertensive Emergency can arise in patients detoxifying from alcohol. Diagnostic and treatment implications are reviewed to help clinicians manage blood pressure in these situations. Data Sources: PubMed was searched with no restrictions on publication date or study type in June 2019 using the terms (alcohol withdrawal) AND hypertension. Study Selection: Of 531 studies retrieved, all were reviewed, and articles older than 20 years were excluded. Of the remaining 158 articles, all were reviewed by full-text reading, and 17 were selected based on relevance. Seven UpToDate articles and 2 older papers were also included for relevance. Data Extraction: Various other searches were also performed; however, no relevant hits resulted when the following terms were entered: (Hypertensive urgency/Emergency) AND alcohol withdrawal OR detoxification; (Hypertensive urgency/Emergency) AND (alcohol withdrawal OR detoxification) AND treatment-resistant hypertension. Results: Hypertension is typically self-limited in alcohol withdrawal syndrome; however, treatment is important to prevent Hypertensive urgency or Emergency. There is a paucity of data on how best to manage hypertension in patients withdrawing from alcohol, with treatment often individualized. Patients with underlying treatment-resistant hypertension may have more difficult-to-control blood pressure, especially in the first 24 hours of withdrawal. Conclusions: Multiple medications may be used to treat hypertension in the setting of alcohol withdrawal, with selection based on side effect profile and the patient's other comorbidities. In patients for whom there is concern for Hypertensive urgency versus Emergency, full medical evaluation is indicated to identify any potential end-organ damage.
-
Hypertensive urgency and Emergency in alcohol withdrawal a literature review
The Primary Care Companion To The Journal of Clinical Psychiatry, 2019Co-Authors: Ermal Bojdani, Tina Zhang, Nida Z Naqvi, Anderson Chen, Dil TaheraAbstract:Objective: To help clinicians recognize that hypertension, Hypertensive urgency, and Hypertensive Emergency can arise in patients detoxifying from alcohol. Diagnostic and treatment implications are reviewed to help clinicians manage blood pressure in these situations. Data Sources: PubMed was searched with no restrictions on publication date or study type in June 2019 using the terms (alcohol withdrawal) AND hypertension. Study Selection: Of 531 studies retrieved, all were reviewed, and articles older than 20 years were excluded. Of the remaining 158 articles, all were reviewed by full-text reading, and 17 were selected based on relevance. Seven UpToDate articles and 2 older papers were also included for relevance. Data Extraction: Various other searches were also performed; however, no relevant hits resulted when the following terms were entered: (Hypertensive urgency/Emergency) AND alcohol withdrawal OR detoxification; (Hypertensive urgency/Emergency) AND (alcohol withdrawal OR detoxification) AND treatment-resistant hypertension. Results: Hypertension is typically self-limited in alcohol withdrawal syndrome; however, treatment is important to prevent Hypertensive urgency or Emergency. There is a paucity of data on how best to manage hypertension in patients withdrawing from alcohol, with treatment often individualized. Patients with underlying treatment-resistant hypertension may have more difficult-to-control blood pressure, especially in the first 24 hours of withdrawal. Conclusions: Multiple medications may be used to treat hypertension in the setting of alcohol withdrawal, with selection based on side effect profile and the patient's other comorbidities. In patients for whom there is concern for Hypertensive urgency versus Emergency, full medical evaluation is indicated to identify any potential end-organ damage.