Risk factors promoting hypertensive crises: evidence from a longitudinal study

Background Current knowledge about risk factors promoting hypertensive crisis originates from retrospective data. Therefore, potential risk factors of hypertensive crisis were assessed in a prospective longitudinal study. Methods Eighty-nine patients of the medical outpatient unit at the University Hospital of Bern (Bern, Switzerland) with previously diagnosed hypertension participated in this study. At baseline, 33 potential risk factors were assessed. All patients were followed-up for the outcome of hypertensive crisis. Cox regression models were used to detect relationships between risk factors and hypertensive crisis (defined as acute rise of systolic blood pressure (BP) ≥200mmHg and/or diastolic BP ≥120mmHg). Results The mean duration of follow-up was 1.6 ± 0.3 years (range 1.0–2.4 years). Four patients (4.5%) were lost to follow-up. Thirteen patients (15.3%) experienced hypertensive crisis during follow-up. Several potential risk factors were significantly associated with hypertensive crisis: female sex, higher grades of obesity, the presence of a hypertensive or coronary heart disease, the presence of a somatoform disorder, a higher number of antihypertensive drugs, and nonadherence to medication. As measured by the hazard ratio, nonadherence was the most important factor associated with hypertensive crisis (hazard ratio 5.88, 95% confidence interval 1.59–21.77, P < 0.01). Conclusions This study identified several potential risk factors of hypertensive crisis. Results of this study are consistent with the hypothesis that improvement of medical adherence in antihypertensive therapy would help to prevent hypertensive crises. However, larger studies are needed to assess potential confounding, other risk factors and the possibility of interaction between predictors.

[Endocrine crises]

Pituitary apoplexy, diabetes insipidus, thyroid storm, myxedema coma, parathyrotoxic crisis, hypocalcemia tetany, pheochromocytoma and Addison crisis, diabetic ketoacidosis, diabetic hyperosmolar nonketotic coma, hypoglycemia and carcinoid crisis are the most important endocrine crises. Some of them are common, others very rare. All physicians nevertheless need to have at least a basic knowledge of all of them, since symptoms and signs of endocrine crises overlap with those of other severe disease states, and the failure to recognise endocrine crises as such and to begin rapidly the specific therapy can have fatal consequences.

The Beauty and the Beast. A Tale of Democratic Crises and Globalization

There are two competing hypotheses concerning the connection between democracy and globalization. The critics hold globalization responsible for an ongoing crisis of democracy. The enthusiasts highlight the positive contributions of financial openness and international political cooperation on the development of democracy. In this contribution the author investigates the interrelation between globalization and the quality of established democracies. He introduces the Democracy Barometer, a new instrument that measures the quality of democracy in 30 established democratic regimes between 1995 and 2005 and that explicitly does not measure sustainable government because it aims at serving as dependent as well as independent variable to explain different economic, societal and natural environment, i.e. sustainable development. Based on this instrument, the author first shows that one cannot speak of an ongoing crisis of (established) democracies. Second, he also conducts several multilevel analyses to model the different developments of the quality of democracy in the different countries. The author then shows that economy, i.e. economic globalization indeed has a positive impact on the quality of democracy. However, this impact is stronger in stable, i.e. older than in younger established democracies. Further investigations show that a high quality of democracy also goes hand in hand with societal and environmental performance.