Who are the patients presenting with a hypertensive crises at the emergency room? A tertiary center experience

Introduction: Hypertension (HTN) is one of the ma-jor health care problems around the world and control rates are still suboptimal which can lead to an excess of hypertensive crises and Emergency Department (ED) presentations. There is a paucity of data on patients with HTN crises presenting to EDs in Romania.

Objective: The aim of the current study is to describe the profile of the patient presenting with a hypertensive crisis at the ED of a tertiary care emergency hospital.

Methods: We retrospectively analysed all the charts of patients presenting at the ED of a tertiary care emergen-cy hospital during 1 month (March 2018). We retrieved complete demographic, clinical, paraclinical and treat-ment data from the ED charts of patients presenting for symptomatic or asymptomatic hypertension defined as blood pressure (BP) ≥140/90 mm Hg. We defined a hypertension emergency (EMG) as BP ≥180/120 mm Hg with acute target organ damage (TOD) and HTN urgency as BP ≥180/120 without TOD (URG). In all other cases BP ≥140/90 mm Hg was referred to as ele-vated BP (EBP).

Results: 5898 patients presented at the ED in 1 month, from which we studied 293 pts evaluated for HTN (4.96% from all presentations). 48.2% were true HTN crises while the reminder presented for EBP. Patients presenting for EMG (only12.2%) were older (EMG vs. URG, 70.0 ± 12.2 vs. 65.1 ± 12.4 years, p=0.02), almost all had previous HTN (EMG vs. URG, 91.6% vs. 72.3%, p=0.00), a higher number of comorbidities (average number of comorbidities (mean ± SD), EMG vs. URG, 1.57 ± 1.14 vs. 1 ± 1.12, p=0.01) including a higher pre-valence of atrial fibrillation (EMG vs. URG, 25% vs. 7.6%, p=0.00). Systolic BP (mmHg) was not different between groups at arrival in the ED (EMG vs URG, (mean ± SD), 200.6 ± 21.0 vs. 195.5 ± 15.1 mmHg, p=0.3) while at leaving the ED sBP was significantly hi-gher in the EMG patients (153.1 ± 22.1 vs. 142.9 ± 13.1 mmHg, p=0.02) which were more likely to be admitted (EMG vs. URG, 63.8% vs. 7.6%, p=0.00).

Conclusions: Hypertensive disease remains a frequent cause of ED presentations with only half of cases repre-senting true urgencies or emergencies, overburdening the emergency health care system. Patients with true hypertensive EMG represent a vulnerable category as they are older, with a higher number of comorbidities making them more likely to be admitted.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)