title: Acute Arterial Hypertension in Acute Pulmonary Edema: Mostly a Trigger or an Associated Phenomenon?
abstract: The role of acute arterial hypertension in acute pulmonary edema (APE) as an associated or triggering phenomenon has been poorly investigated and is relevant to patient management.
  
  
  
  This was a prospective observational study of clinical, electrocardiographic, and echocardiographic characteristics of patients with APE. Potential triggers, including acute coronary syndrome (ACS), rapid atrial fibrillation (AF) (≥ 120 bpm in AF), fever > 38°C or volume overload, isolated acute hypertension (systolic blood pressure ≥ 170 mm Hg), and unknown factors were investigated.
  
  
  
  There were 742 patients, 578 with coronary artery disease (78%), 116 with valvular heart disease or cardiomyopathy (16%), and 47 without identifiable heart disease (6%). ACS was present in 482 (65%) patients (silent in 154 of them), AF was present in 76 (10%) patients, fever/volume overload was present in 62 (8%) patients, acute hypertension was present in 50 (7%) patients, and no apparent trigger was seen in 72 (10%) patients. Admission hypertension occurred in 260 patients (35%): 155 (60%) with ACS (silent in 49 [32%]), 36 (14%) with AF, 19 (7%) with fever/volume overload, and 59 (19%) as an isolated trigger. Similar results were obtained when analyzing patients using coronary angiography (467 patients [63%]). Acute hypertension was present more frequently in patients with severe hypoventilation (arterial Pco2> 60 mm Hg) than in those without (57% vs 29%; P < 0.001) and in those without moderate-severe mitral regurgitation than in those with (51% vs 30%; P < 0.001).
  
  
  
  In patients with APE, with or without ACS, acute hypertension is often present but mainly as an associated/reactive phenomenon and seems favoured by severe hypoventilation. Silent myocardial ischemia/necrosis deserves systematic investigation because it is not rare that it may be the underlying cause of APE.
authors.affiliation: Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: 5751jfb@gmail.com.
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.affiliation: Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bañeras
authors.affiliation: Complexo Hospitalario Universitario de Vigo, Sergas, Vigo, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Peña-Gil
authors.affiliation: Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.affiliation: Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Barrabés
authors.affiliation: Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodriguez Palomares
authors.affiliation: Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis; D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis; D001810:Blood Volume; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D052279:Creatine Kinase, MB Form / Q000097:blood; D004452:Echocardiography; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007040:Hypoventilation / Q000150:complications / Q000175:diagnosis; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000150:complications*; D014883:Water-Electrolyte Imbalance
chemical_list: D052279:Creatine Kinase, MB Form