Hospital Admissions for Hypertensive Crisis in the Emergency Departments: A Large Multicenter Italian Study

Abstract

Epidemiological data on the impact of hypertensive crises (emergencies and urgencies) on referral to the Emergency Departments (EDs) are lacking, in spite of the evidence that they may be life-threatening conditions. We performed a multicenter study to identify all patients aged 18 years and over who were admitted to 10 Italian EDs during 2009 for hypertensive crises (systolic blood pressure ≥220 mmHg and/or diastolic blood pressure ≥120 mmHg). We classified patients as affected by either hypertensive emergencies or hypertensive urgencies depending on the presence or the absence of progressive target organ damage, respectively. Logistic regression analysis was then performed to assess variables independently associated with hypertensive emergencies with respect to hypertensive urgencies. Of 333,407 patients admitted to the EDs over the one-year period, 1,546 had hypertensive crises (4.6/1,000, 95% CI 4.4–4.9), and 23% of them had unknown hypertension. Hypertensive emergencies (n = 391, 25.3% of hypertensive crises) were acute pulmonary edema (30.9%), stroke (22.0%,), myocardial infarction (17.9%), acute aortic dissection (7.9%), acute renal failure (5.9%) and hypertensive encephalopathy (4.9%). Men had higher frequency than women of unknown hypertension (27.9% vs 18.5%, p<0.001). Even among known hypertensive patients, a larger proportion of men than women reported not taking anti-hypertensive drug (12.6% among men and 9.4% among women (p<0.001). Compared to women of similar age, men had higher likelihood of having hypertensive emergencies than urgencies (OR = 1.34, 95% CI 1.06–1.70), independently of presenting symptoms, creatinine, smoking habit and known hypertension. This study shows that hypertensive crises involved almost 5 out of 1,000 patients-year admitted to EDs. Sex differences in frequencies of unknown hypertension, compliance to treatment and risk of hypertensive emergencies might have implications for public health programs.

Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting

“…Despite the common nature of the problem, a surprising lack of literature characterizes hypertensive urgency and its outcomes, particularly in the ambulatory setting. Prior studies 10,18,19 report the prevalence of hypertensive crisis in the ED to range from 0.5% to 3% of visits, including those for asymptomatic and symptomatic urgency and patients with emergent visits. In comparison, we found that hypertensive urgency was present in nearly 5% of patients in the office setting, although few were referred to the hospital for management.…”

Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)

“…cerebral hemorrhage, ischemic stroke, acute pulmonary edema and myocardial infarction [11], although the overall occurrence of these clinical events has not been systematically investigated in cardiovascular autonomic failure. Acute cardiovascular complications associated with nSH have been reported, but mainly in patients also receiving anti-hypotensive drugs [12, 13], which are known to induce or exacerbate nSH (Fig.…”

Crise hipertensiva na odontologia

“…A crise hipertensiva pode ou não estar associada a lesões de órgãos-alvo, diferenciando as emergências hipertensivas das urgências hipertensivas 2, 4,5,14,15 . Pacientes que passaram por uma situação de urgên-cia ou emergência hipertensiva têm maior chance de desenvolver outras patologias em um período de dois anos, tais como síndromes isquêmicas agudas, acidente vascular encefálico, fibrilação atrial, edema agudo de pulmão e dissecção aórtica 4 .…”