Diagnosis and Management of Hypertensive Emergency in a Patient With Generalized Anxiety Disorder

Aldis H. Petriceks, BA; Theodore A. Stern, MD

Prim Care Companion CNS Disord 2022;24(6):21f03154

LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

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References (32)

Elliot WJ, Varon J. Evaluation and treatment of hypertensive emergencies in adults. UpToDate website. 2020. Accessed September 14, 2022. https://www.uptodate.com/contents/evaluation-and-treatment-of-hypertensive-emergencies-in-adults
Peixoto AJ. Acute severe hypertension. N Engl J Med. 2019;381(19):1843–1852. PubMed CrossRef
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356(9227):411–417. PubMed CrossRef
Kumari R, Kapil A, Grewal V, et al. Hypertensive emergency: a look into the eye. Postgrad Med J. 2021;98(e1):140389. PubMed CrossRef
Elliott WJ, Weber RR, Nelson KS, et al. Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation. 1990;81(3):970–977. PubMed CrossRef
Elliott WJ. Clinical features and management of selected hypertensive emergencies. J Clin Hypertens (Greenwich). 2004;6(10):587–592. PubMed CrossRef
Lin MP, Liebeskind DS. Imaging of ischemic stroke. Continuum (Minneap Minn). 2016;22(5, Neuroimaging):1399–1423. PubMed CrossRef
Potter T, Schaefer TJ. Hypertensive encephalopathy. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022.
Strandgaard S, Paulson OB. Cerebral blood flow and its pathophysiology in hypertension. Am J Hypertens. 1989;2(6 Pt 1):486–492. PubMed CrossRef
Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension. 2019;73(5):e35–e66. PubMed CrossRef
Patel KK, Young L, Howell EH, et al. Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting. JAMA Intern Med. 2016;176(7):981–988. PubMed CrossRef
Saguner AM, Dür S, Perrig M, et al. Risk factors promoting hypertensive crises: evidence from a longitudinal study. Am J Hypertens. 2010;23(7):775–780. PubMed CrossRef
Johnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiol Clin. 2012;30(4):533–543. PubMed CrossRef
Katz JN, Gore JM, Amin A, et al; STAT Investigators. Practice patterns, outcomes, and end-organ dysfunction for patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension (STAT) registry. Am Heart J. 2009;158(4):599–606.e1. PubMed CrossRef
Mayer SA, Kurtz P, Wyman A, et al; STAT Investigators. Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry. Crit Care Med. 2011;39(10):2330–2336. PubMed CrossRef
Alshami A, Romero C, Avila A, et al. Management of hypertensive crises in the elderly. J Geriatr Cardiol. 2018;15(7):504–512. PubMed.
Peacock F, Amin A, Granger CB, et al; Stat Investigators. Hypertensive heart failure: patient characteristics, treatment, and outcomes. Am J Emerg Med. 2011;29(8):855–862. PubMed CrossRef
Campbell P, Baker WL, Bendel SD, et al. Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified. J Am Soc Hypertens. 2011;5(6):473–477. PubMed CrossRef
Breu AC, Axon RN. Acute treatment of hypertensive urgency. J Hosp Med. 2018;13(12):860–862. PubMed CrossRef
Hamam MS, Kunjummen E, Hussain MS, et al. Anxiety, depression, and pain: considerations in the treatment of patients with uncontrolled hypertension. Curr Hypertens Rep. 2020;22(12):106. PubMed CrossRef
Roest AM, Martens EJ, de Jonge P, et al. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010;56(1):38–46. PubMed CrossRef
Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627. PubMed CrossRef
White WB, Baker LH. Episodic hypertension secondary to panic disorder. Arch Intern Med. 1986;146(6):1129–1130. PubMed CrossRef
Mann SJ. Severe paroxysmal hypertension (pseudopheochromocytoma). Curr Hypertens Rep. 2008;10(1):12–18. PubMed CrossRef
Kim CH, Syed S. Hypertensive encephalopathy: a case of a male who bit off his fingers. Cureus. 2017;9(6):e1334. PubMed CrossRef
Flockhart DA. Dietary restrictions and drug interactions with monoamine oxidase inhibitors: an update. J Clin Psychiatry. 2012;73(suppl 1):17–24. PubMed CrossRef
Morreale MK, Wake LA. Psychiatric medications and hypertension. Curr Hypertens Rep. 2020;22(11):86. PubMed CrossRef
Thase ME. Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3744 depressed patients. J Clin Psychiatry. 1998;59(10):502–508. PubMed CrossRef
Stein DJ, Aguilar-Gaxiola S, Alonso J, et al. Associations between mental disorders and subsequent onset of hypertension. Gen Hosp Psychiatry. 2014;36(2):142–149. PubMed CrossRef
Hofmann SG, Asmundson GJG. Acceptance and mindfulness-based therapy: new wave or old hat? Clin Psychol Rev. 2008;28(1):1–16. PubMed CrossRef
Calhoun DA, Harding SM. Sleep and hypertension. Chest. 2010;138(2):434–443. PubMed CrossRef
Choudhury A, Lip GYH. Exercise and hypertension. J Hum Hypertens. 2005;19(8):585–587. PubMed CrossRef