Clinical treatment outcomes of hypertensive emergency patients: Results from the hypertension registry program in Northeastern Thailand

Abstract 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

The effect of pursed‐lip breathing combined with number counting on blood pressure and heart rate in hypertensive urgency patients: A randomized controlled trial

Abstract 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

The effects of foot reflexology on blood pressure and heart rate: A randomized clinical trial in stage‐2 hypertensive patients

Abstract 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