The Clinical Presentation of Hypertensive Crisis in the Emergency Department of Baghdad Teaching Hospital
Iraqi Postgraduate Medical Journal,
2014, Volume 13, Issue 4, Pages 515-523
Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure ≥180 mm Hg or a diastolic blood pressure ≥120 mm Hg which is potentially fatal. It can manifest as either hypertensive emergency or urgency, depending on end-organ damage including cardiac, renal, retinal and neurologic injury.
To analyze the clinical presentation, and characteristics of patients presented with hypertensive crisis and to assess the frequency of the target organs involved.
An 8 months cross sectional study in which 306 patients older than 18 years who attended the medical emergency department of Baghdad Teaching Hospital with a hypertensive crisis were selected; excluding cases of preeclampsia and eclampsia. The criteria that were used were based on the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure which was the latest report at the time of the study. Patients were differentiated into hypertensive emergency or urgency, and were divided according to age into five groups: ≤30y, 30-39y, 40-49y, 50-59y, ≥60y. From each patient, a clinical history, physical examination including fundoscopy, blood analysis, electrocardiogram, and a chest X-ray were obtained. Computarised tomography was done when indicated.
Hypertensive emergency was found in 60.8% and hypertensive urgency in 39.2% of cases. Of total; 56.2% were males. Mean age of total sample was 48.7 ± 16.2y, but patients with a hypertensive emergency were older with statistically significant difference. Hypertension was unknown to 48% of patients.Twenty-four percent of patients were diabetics. Smoking and dyslipidemia were significant risk factors. Hypertensive emergency presented with dyspnea in (30%), and papilledema was found in (18.63%) with statistically significant difference. Patients with hypertensive urgency presented with epistaxis in (11.90%), and papilledema was found in (9.80%). Most cases of hypertensive emergency corresponded to acute myocardial infarction (25.3%) followed by encephalopathy (21.0%), renal failure (20.4%), heart failure (17.2%), and cerebrovascular accident (11.3%).
Hypertensive emergency was more frequent, males were more frequently affected and were significantly older than those with a hypertensive urgency. Smoking & dyslipidemia were significant risk factors. Hypertension was unknown to about half of patients. The most frequent clinical manifestations were papilledema and dyspnea. Acute myocardial infarction, encephalopathy, and renal failure were the most frequent target organ lesions in hypertensive emergency.
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