Vallelonga Fabrizio, Carbone Federica, Benedetto Francesco, Airale Lorenzo, Totaro Silvia, Leone Dario, Astarita Anna, Avenatti Eleonora, Maule Simona, Veglio Franco, Lupia Enrico, Milan Alberto
Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy.
Division of Emergency Medicine, AOU Città Salute e Scienza, Torino, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
J Clin Med. 2020 Jul 12;9(7):2201. doi: 10.3390/jcm9072201.
A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders.
Data from 718 patients presenting to the emergency department of the "Città della Salute e della Scienza" Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed.
A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity.
Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.
最近提出了一种基于症状分级的诊断策略，该策略依赖于五种主要症状（胸痛、急性呼吸困难、神经症状、头痛、视力障碍）的存在来诊断高血压急症患者。然而，关于症状在急性高血压疾病的诊断和管理中的作用，目前可获得的科学证据较少。
回顾性分析了718例就诊于都灵“城市健康与科学”医院急诊科、收缩压>180和/或舒张压>110 mmHg的患者的数据。评估了典型症状识别高血压急症的准确性。
718例患者中共有79例（11%）被诊断为高血压急症（51%有心血管急性器官损害，49%有神经血管急性器官损害）。与未控制高血压的患者相比，高血压急症患者年龄更大，冠状动脉疾病和慢性心力衰竭的患病率更高。典型症状能够以64%的准确率、94%的敏感性和60%的特异性将真正的高血压急症与未控制的高血压区分开来。
典型症状可在急诊科用作一种简单的筛查试验（阴性预测值为99%），以在急性高血压疾病患者中选择疑似高血压急症患者进行进一步评估。
