Hypertensive crisis (HC), characterized as sudden and symptomatic elevation in the blood pressure, with or without risk of target organ damage, can be classified in hypertensive emergency (HE) and hypertensive urgency (HU), respectively. Evidence shows that endothelial dysfunction and coagulation biomarkers play an important role in the pathophysiology of chronic high blood pressure (BP). However, few studies demonstrate the involvement of these biomarkers in the pathogenesis of acute BP elevation. Thus, this study had the objectives: to characterize biochemical profile of HU and HE, and to evaluate the participation of C-reactive protein (CRP), intercellular adhesion molecule (ICAM-1) and coagulation factors (fibrinogen and PAI-1) in subjects with HC.Design and method:
It was a cross-sectional study with 74 normotensive (NT), 74 controlled hypertensive (CHT), 50 with HU and 78 individuals with HE. It was used MULTIPLEX technique for evaluating the clotting factors. Analysis of variance was used for comparative study among the groups, with significant p-value < 0.05.Results:
The diastolic BP and heart rate were higher in the HC group (120mmHg and 85bpm, respectively) compared to the CHT group (75mmHg and 68 bpm, respectively). Individuals with HE were older. Glycaemia was significantly higher in the HE group (113 mg/dL) versus NT and CHT (91 mg/dL and 98 mg/dL, respectively; p < 0.05). It was also higher in the HU group (109 mg/dL) compared to NT. Potassium was significantly lower in HE group (4,2mEq/l) compared to NT, CHT and HU groups (4.5, 4.4 and 4.4mEq/L, respectively). CRP, fibrinogen, and PAI-1 were significantly higher in patients with HE (0.75, 0.04 and 2.46, respectively) in comparison to NT (0.19, 0.01 and 2.1, respectively) and CHT (0.14, 0.01 and 2.25, respectively) groups, except ICAM-1. Logistic regression showed that CRP and fibrinogen were markers for HC development with odds ratios of 2.6 (1.24 to 5.50) and 8.72 (4.07 to 18.68), respectively.Conclusions:
HC individuals have metabolic abnormalities compared to controls. Biomarkers of endothelial dysfunction and coagulation factors are higher in HU and HE groups compared to control groups. This suggests the role of endothelial dysfunction biomarkers and coagulation factors in the pathogenesis of acute hypertensive event.