Prevalence of Neurological Complaints in Severe Hypertension

William Mullally^*
*Correspondence: William Mullally, Department of Neurology, Boston University, Boston, USA, Email:

Keywords

Hypertension • Headache • Neurological complaints • Blood pressure

Introduction

Headache is a common neurological complaint reported by patients with severe hypertension. The prevalence of headache in hypertensive emergencies varies among studies, but it is frequently observed, particularly in patients with accelerated hypertension. Headaches in severe hypertension are often described as severe, throbbing, and persistent. They are commonly associated with other symptoms, such as visual disturbances or confusion. Visual disturbances, including blurred vision, photophobia, and visual field deficits, are neurological complaints frequently reported in patients with severe hypertension. These visual symptoms can result from retinal changes, which may be an indicator of end-organ damage in the eye due to severe hypertension. Timely recognition of hypertensive retinopathy can aid in the early detection and management of severe hypertension, preventing further complications. Severe hypertension can cause confusion and altered mental status due to cerebral edema and impaired cerebral perfusion. Patients may present with disorientation, cognitive impairment, or even coma in severe cases. This neurological manifestation should prompt ED healthcare providers to consider hypertensive encephalopathy, a life-threatening complication of severe hypertension requiring immediate intervention.

Literature Review

In some cases, severe hypertension can cause focal neurological deficits resembling stroke symptoms. These deficits may include unilateral weakness, sensory changes, or speech disturbances. Differentiating between hypertensive emergency-related neurological deficits and acute stroke is crucial to ensure appropriate and timely management. The severity of neurological complaints in patients with severe hypertension may be influenced by the degree of blood pressure elevation. Higher SBP and DBP levels are associated with more pronounced neurological symptoms, reflecting the potential impact of greater vascular strain on the central nervous system. The presence of coexisting medical conditions, such as diabetes, chronic kidney disease, or previous cerebrovascular disease, can exacerbate neurological complaints in severe hypertension. These conditions may contribute to end-organ damage and increase the vulnerability of the brain to the effects of hypertension. The prevalence and severity of neurological complaints in severe hypertension may vary with age and gender. Older individuals and males may be more susceptible to certain neurological manifestations due to differences in vascular reactivity and cerebral autoregulation. Inadequate adherence to antihypertensive medications can lead to poorly controlled blood pressure, increasing the risk of hypertensive emergencies and neurological complaints. Patients with a history of medication non-adherence may require additional attention and education to improve their compliance.

Discussion

The management of neurological complaints in patients with severe hypertension involves a comprehensive approach that addresses both the acute symptoms and the underlying cause of hypertensive emergency. Immediate blood pressure reduction is essential in hypertensive emergencies to prevent further end-organ damage. Intravenous antihypertensive agents, such as nitroprusside, labetalol, are commonly used to achieve gradual blood pressure reduction. Rapid neurological assessment is crucial to identify any focal deficits or altered mental status in patients with severe hypertension. This assessment helps differentiate between hypertensive emergencyrelated neurological symptoms and other potential causes, such as stroke. Continuous monitoring of blood pressure and vital signs is essential to guide treatment and assess the response to therapy. Additionally, clinicians should evaluate the impact of severe hypertension on other organs, such as the heart, kidneys, and eyes, to identify any end-organ damage and guide management decisions. Efforts should be made to identify and treat any underlying triggers of severe hypertension, such as medication non-adherence, illicit drug use, or acute stressors. Treating the underlying cause can help prevent recurrent hypertensive emergencies.

Neurological complaints are prevalent among patients presenting to the emergency department with severe hypertension. Headache, visual disturbances, confusion and focal neurological deficits are commonly reported symptoms. Prompt recognition and appropriate management of neurological manifestations in severe hypertension are crucial to prevent further complications and improve patient outcomes. Emergency department healthcare providers should be vigilant in assessing and managing these patients, emphasizing the importance of blood pressure control and the early identification of end-organ damage. Timely intervention can significantly impact the course of hypertensive emergencies and reduce the morbidity associated with neurological complications. Hypertension, commonly known as high blood pressure, is a prevalent medical condition that affects a significant proportion of the global population. Uncontrolled hypertension can lead to severe complications, including cardiovascular events, renal dysfunction, and neurological manifestations. Neurological complaints in patients with severe hypertension are a significant concern due to the potential for serious and potentially life-threatening complications, such as hypertensive encephalopathy, stroke, or subarachnoid hemorrhage. This article aims to explore the prevalence of neurological complaints among emergency department patients with severe hypertension, emphasizing the importance of prompt recognition and appropriate management in this patient population.

Hypertensive encephalopathy is a potentially life-threatening condition characterized by cerebral edema, altered mental status, seizures and focal neurological deficits. It typically occurs in the setting of severe hypertension, often with systolic blood pressure exceeding or diastolic blood pressure exceeding. The prevalence of hypertensive encephalopathy among emergency department patients with severe hypertension varies, with reported rates. Prompt recognition and blood pressure control are crucial to prevent neurological deterioration and long-term complications. Severe hypertension is a significant risk factor for ischemic stroke, which occurs due to the disruption of blood flow to the brain. Acute ischemic stroke can present with various neurological symptoms, including sudden onset focal weakness, speech disturbances, sensory deficits, or visual disturbances. The prevalence of ischemic stroke among emergency department patients with severe hypertension highlighting the importance of evaluating all patients presenting with neurological complaints for possible stroke.

Subarachnoid hemorrhage is a medical emergency characterized by bleeding into the space surrounding the brain. Hypertension is a leading risk factor for SAH, and patients with severe hypertension may present with symptoms such as sudden severe headache, neck stiffness, altered mental status, or focal neurological deficits. The reported prevalence of SAH among emergency department patients with severe hypertension ranges. Early recognition and appropriate management are crucial for optimizing outcomes in SAH cases. Severe hypertension can also contribute to other neurological complaints, such as transient ischemic attacks hypertensive retinopathy, or posterior reversible encephalopathy syndrome. TIAs are brief episodes of neurological dysfunction that resolve within 24 hours, often serving as warning signs of an impending stroke. Hypertensive retinopathy refers to retinal changes due to hypertensive vascular damage and can manifest as visual disturbances or retinal hemorrhages. PRES is a reversible syndrome characterized by headaches, seizures, altered mental status, and visual disturbances. The prevalence of these manifestations among emergency department patients with severe hypertension varies, but prompt evaluation and appropriate management are essential to prevent further complications.

Timely recognition and appropriate management of neurological complaints among emergency department patients with severe hypertension are crucial for optimizing patient outcomes. The initial evaluation should include a comprehensive neurological examination, blood pressure measurement, and appropriate diagnostic studies to identify the underlying cause of the neurological symptoms. Immediate blood pressure control is a priority in patients with severe hypertension and neurological complaints. Intravenous antihypertensive medications, such as labetalol, are commonly used to lower blood pressure to safe levels while maintaining cerebral perfusion. However, cautious blood pressure reduction is important to prevent exacerbation of ischemic events in patients with compromised cerebral blood flow. Specific management strategies depend on the underlying cause of the neurological complaints. For example, in the case of hypertensive encephalopathy, prompt blood pressure reduction is essential to alleviate cerebral edema and prevent further neurological deterioration. Ischemic stroke management includes thrombolytic therapy, mechanical thrombectomy, or supportive care depending on the individual patient's eligibility and time of symptom onset. In cases of SAH, immediate neurosurgical consultation and appropriate interventions, such as endovascular coiling or surgical clipping, are often necessary [1-6].

Conclusion

Furthermore, long-term management of severe hypertension is crucial to prevent recurrent neurological events. Lifestyle modifications, such as dietary changes, exercise, weight loss, and smoking cessation, are key components of hypertension management. Pharmacological therapy, including antihypertensive medications, is often necessary to achieve and maintain target blood pressure levels. Neurological complaints among emergency department patients with severe hypertension are relatively common and require prompt recognition and appropriate management to prevent serious complications. The prevalence of neurological manifestations, such as hypertensive encephalopathy, ischemic stroke and subarachnoid hemorrhage, varies among this patient population. Timely evaluation, blood pressure control, and targeted interventions are essential to optimize outcomes and minimize the risk of longterm neurological sequelae. Improving awareness among healthcare providers about the prevalence and implications of neurological complaints in severe hypertension is crucial for enhancing patient care and reducing the burden of neurological complications associated with this condition.

Acknowledgement

None

Conflict of Interest

None

References

1. Hannan, Md Abdul, Md Nazmul Haque, Raju Dash and Mahboob Alam, et al. "3β, 6β-dichloro-5-hydroxy-5α-cholestane facilitates neuronal development through modulating TrkA signaling regulated proteins in primary hippocampal neuron."Sci Rep 9 (2019): 18919.

Google Scholar, Crossref, Indexed at

2. Petrovska, Biljana Bauer and Svetlana Cekovska. "Extracts from the history and medical properties of garlic."Pharmacogn Rev 4 (2010): 106.

Google Scholar, Crossref, Indexed at

3. Marón, Feres José Mocayar, Alejandra Beatriz Camargo and Walter Manucha. "Allicin pharmacology: Common molecular mechanisms against neuroinflammation and cardiovascular diseases."Life Sci249 (2020): 117513.

Google Scholar, Crossref, Indexed at

4. Nadeem, Muhammad Shahid, Imran Kazmi, Inam Ullah and Khushi Muhammad, et al. "Allicin, an antioxidant and neuroprotective agent, ameliorates cognitive impairment."Antioxidants11 (2021): 87.

Google Scholar, Crossref, Indexed at

5. Ahangar-Sirous, Ramin, Mohadeseh Poudineh, Arina Ansari and Ali Nili, et al. "Pharmacotherapeutic potential of garlic in age-related neurological disorders."CNS Neurol Disord Drug Targets21 (2022): 377-398.

Google Scholar, Crossref, Indexed at

6. Park, Hyeon, Geun Hee Seol, Sangwoo Ryu and In-Young Choi. "Neuroprotective effects of (−)-linalool against oxygen-glucose deprivation-induced neuronal injury."Arch Pharm Res 39 (2016): 555-564.

Google Scholar, Crossref, Indexed at