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Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community
Frederick A Waldron1, Irina Benenson2, Shelley A Jones-Dillon1
1a Department of Emergency Medicine , Newark Beth Israel Medical Center , Newark , New Jersey , USA.
Insights
Hypertensive crisis is highly prevalent in African Americans, with older age and certain health conditions increasing risk for hypertensive emergencies. Race was not a significant factor in developing these emergencies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Hypertensive crisis, encompassing hypertensive emergency and urgency, represents a critical concern in cardiovascular health.
- Understanding the prevalence and risk factors for hypertensive crisis is vital, particularly in high-risk populations.
- African Americans experience disproportionately higher rates of hypertension and its complications.
Purpose of the Study:
- To determine the prevalence of hypertensive crisis and its subtypes (emergency and urgency) in a predominantly African American population.
- To identify key risk factors associated with the development of hypertensive emergencies.
- To assess the likelihood of acute target organ damage in patients with confirmed hypertension and crisis.
Main Methods:
- A 3-year case-control study utilized emergency department medical records of patients with diagnosed hypertension.
- Cases (hypertensive crisis, BP ≥ 200/120 mmHg) were matched 1:1 with controls (hypertension, BP < 200/120 mmHg) by age, gender, and race.
- Demographic and clinical variables were compared between cases and controls, and between hypertensive emergencies and urgencies.
Main Results:
- The prevalence of hypertensive crisis was 11.4%, with hypertensive emergencies accounting for 3.2% of the study population (28% of crisis cases).
- Predictors for hypertensive emergencies included older age, male gender, anemia, coronary artery disease, congestive heart failure, and chronic renal insufficiency.
- Healthcare insurance and access to care did not reduce the odds of hypertensive emergencies; race was not a significant risk factor.
Conclusions:
- Hypertensive crisis and emergencies are highly prevalent in this urban, predominantly African American population, exceeding the US average fivefold.
- While certain comorbidities increase risk, race is not a predictor for developing hypertensive emergencies or acute target organ damage.
- These findings underscore the need for targeted interventions and management strategies for hypertensive crisis in at-risk communities.
Purpose:
A 3-year case control study was conducted to determine the prevalence of hypertensive crisis and its subtypes, hypertensive emergency and hypertensive urgency. The secondary objectives were to identify risk factors for hypertensive emergencies and to determine the odds of developing acute target organ damage among predominantly African American patients with a confirmed diagnosis of hypertension.
Materials And Methods:
Using emergency department medical records, patients with a confirmed diagnosis of hypertension were identified. From the pool of hypertensive patients, cases and controls were selected and matched 1:1 for age, gender and race. Cases were hypertensive patients with hypertensive crisis, defined as BP ≥ 200/120 mmHg. Controls had a diagnosis of hypertension and BP < 200/120 mmHg. Cases and controls, as well as cases with hypertensive emergencies and hypertensive urgencies were compared based on important demographic and clinical variables.
Results:
Almost 90% of study population were African Americans. The prevalence of hypertensive crisis was 11.4% and hypertensive emergencies was 3.2%. Hypertensive emergencies accounted for 28% of patients with crisis. The predictors for hypertensive emergencies were older age (p = .002), male gender (p < .007), anemia (p < .0001), history of coronary artery disease (p < .001), congestive heart failure (p < .001) and chronic renal insufficiency (p < .001). Having healthcare insurance and access to medical care did not reduce the odds of developing hypertensive emergencies. Race was not a significant risk factor in the progression from hypertensive crisis to hypertensive emergencies (p = .47).
Conclusions:
The study highlights the high prevalence of hypertensive crisis and hypertensive emergencies in the predominantly African American urban population, which is 5 times the United States average. However, race is not a predictor of development of hypertensive emergencies and acute target organ damage in patients with already severely elevated blood pressure.
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