Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study

Abstract

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.

Clinical Profile of Patients with Hypertensive Crisis Presenting to an Emergency Department of a Tertiary Care Hospital in Western India

“…This study comprehends and adds to the existing literature regarding the underlying mechanisms of hypertensive crisis. The incidence of HTN-E and HTN-U was 68.5% and 31.5%, respectively, which is consistent with similar studies by Singh et al and Shao et al [1,4] However, the incidence of HTN-U is increasing due to an increase in awareness on HTN and its screening procedures. One of the nonmodifiable risk factors for HTN is age.…”

“…Hypertensive emergency (HTN-E) is characterized by the presence of target organ damage unlike hypertensive urgency (HTN-U). [1] In accordance with estimates in India, at least one in four persons have HTN; however, only 12% of the population have their blood pressure under control. [2] Moreover, HTN is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India.…”

Burden and outcomes of chronic kidney disease in patients presenting with hypertensive crisis

“…27 Eight percent of patients (8/100) in the retrospective study by Singh et al from Haryana had CKD and 24 had renal dysfunction overall. 9 Twelve% of patients admitted to the ICU for HTN-E (6/50) had CKD in a study from Maharashtra. 10 Only HTN-E was studied; in contrast, 13%(16/127) of the CKD group in the current study had HTN-U.…”

“…12 Outcomes in terms of mortality were not studied in the remaining four. [8][9][10]29 Sustained hypertension can lead to worsening kidney function, and a progressive decline in kidney function can lead to worsening blood pressure control. 4 The CKD group in this study had poorer blood pressure control and renal function at discharge and at the month follow-up when compared to the non-CKD group despite better compliance to anti-hypertensive therapy (Table 4).…”

“…7 There are a few studies from India on hypertensive crises, but none have evaluated and explored the relationship with CKD. [8][9][10][11][12] In Asia, stroke was the most common presentation of hypertensive emergencies, according to a review in 2022. The presence of CKD was not examined.…”