Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

Abstract

Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

“…Patients with hypertensive emergencies had higher prevalence of coronary artery disease and chronic heart failure compared to uncontrolled hypertension in our population, once again in line with previous reports [ 4 , 19 ]. This finding may explain the greater use of beta-blockers, loop diuretics and acetylsalicylic acid in the former group.…”

Clinico-epidemiological characteristics and survival outcome of patients with hypertensive crisis at Kassala Hospital, Eastern Sudan

“…The main indings of this study was that the prevalence of hypertensive crisis among patients admitted to the medical emergency room at kassala teaching hospital was .81%, which is comparable to other study conducted by Carrillo et al, who reported a prevalence of HC of 0.6% among patients brought to the clinical emergency department in a Spanish university-af iliated hospital [11]. However it is inconsistent with the studies from Italy, Brazil, Bosnia and Pakistan where estimated prevalence of HC was reported as 3%,16%,47.2%and 56% respectively [1,[12][13][14]. The difference in the prevalence rate of HC between the later studies and our result may be justi ied by inclusion of hypertensive pseudocrisis which may mimic hypertensive urgency, which may alter the inal results of the study.…”

Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department

“…However, they were compatible with a much used definition for hypertensive crisis and with the findings of an international study on the clinical manifestations of patients with hypertensive crisis. ( 17 ) This data was expected, since the concept of hypertensive crisis used supports high blood pressure values. However, in the second blood pressure measurement, a reduction in blood pressure levels was observed, presuming the efficacy of the treatment conducted.…”