Evidence map›Paper›PMID 25598731›Full record

ReviewOchsner journal2014

Acute hypertension: a systematic review and appraisal of guidelines.

Kirk J Pak, Tian Hu, Colin Fee, Richard Wang, Morgan Smith, Lydia A Bazzano

Abstract readReview
PubMed Full text at PMC
In one paragraph

Review in Ochsner journal, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. A Systematic Review and Meta-analysis of the Clinical and Epidemiological Characteristics of Patients with Hypertensive Emergencies: Implication for Risk Stratification.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2023
    Pooled it
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  10. Research Progress in Acute Hypertensive Renal Injury by "Journal of translational internal medicine · 2019
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  16. Dental management in patients with hypertension: challenges and solutions.Clinical, cosmetic and investigational dentistry · 2016
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Kirk J PakDepartment of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA.
Tian HuDepartment of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
Colin FeeDepartment of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA.
Richard WangThe University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Morgan SmithThe University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Lydia A BazzanoDepartment of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA ; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFew clinical practice guidelines provide management recommendations for acute hypertensive episodes except in the context of specific conditions such as pregnancy and stroke.

methodsWe performed a systematic search to identify guidelines addressing acute hypertension and appraised the guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) validated quality assessment tool. Two reviewers independently appraised and one extracted key recommendations. Literature on secondary hypertension, hypertension in pregnancy, preeclampsia/eclampsia, stroke, aortic dissection, and pheochromocytoma was excluded.

resultsThree guidelines were identified, sponsored by the American College of Emergency Physicians (ACEP), the National Heart, Lung, and Blood Institute (NHLBI), and the European Society of Hypertension (ESH) in conjunction with the European Society of Cardiology (ESC). AGREE II yielded mean domain (%) and overall assessment scores (1-7) as follows: NHLBI: 73%, 5.5; ACEP: 67%, 5.5; and ESH/ESC: 56%, 4.5. In hypertensive emergencies, the NHLBI guideline recommends reducing mean arterial pressure by ≤25% for the first hour, and then to 160/100-110 mmHg by 2-6 hours with subsequent gradual normalization in 24-48 hours. The ESH/ESC has similar recommendations. The ACEP does not address guidelines for hypertensive emergency but focuses on whether screening for target organ damage or medical intervention in patients with asymptomatic elevated blood pressure in emergency departments reduces the rate of adverse outcomes, concluding that routine screening does not reduce adverse outcomes, but patients with poor follow-up may benefit from routine screening.

conclusionNHLBI and ESH/ESC guidelines are high quality and provide similar recommendations for management of asymptomatic acute hypertensive episodes and hypertensive emergencies. Additional research is needed to inform clinical practice guidelines for this common condition.

Indexed as

Acute diseasearterial pressureblood pressureemergency treatmenthypertension–malignantpractice guidelines as topic

Identifiers

PMID25598731
PMCPMC4295743

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.