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

Abstract

Objectives: A hospital-based retrospective study was undertaken among the adult patients presenting to document the incidence of hypertensive urgency (HTN-U) and emergency while the secondary objectives included clinical presentations, disposition from emergency room, and inhospital mortality. Materials and Methods: All patients were evaluated by vital signs, clinical examination as well as relevant laboratory tests and radiological tests. Patients with target organ damage were grouped under the hypertensive emergency (HTN-E) group (n = 104) and patients without target organ damage were included under the HTN-U group (n = 52). The data were analyzed using GraphPad Prism (vs. 9.4.1) and MedCalc (vs. 20.118). Results: The incidence of HTN-E and HTN-U was 68.4% and 31.6%, respectively. The most common symptom observed in patients with HTN-E was breathlessness (53.8%), followed by chest pain (34.6%) and headache (27.9%). While, in HTN-U patients, most patients reported chest pain (43.8%), headache (39.6%), and epistaxis (22.9%). Majority of the patients in both the groups presented with signs of tachycardia, tachypnea, and hypoxia. The mortality in HTN-E and HTN-U patients was 15.4% and 2.1%, respectively. Among 104 patients with HTN-E, 53.8% each of the patients had acute heart failure and acute pulmonary edema. While, in HTN-U patients, acute pulmonary edema and acute coronary syndrome were observed in 2.1% each of the study subjects. Conclusion: Patients at high risk or end-organ damage should be immediately referred to the emergency department from the outpatient settings, as a rapid reduction in blood pressure is essential over minutes to hours, to prevent further organ damage.