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Prevalence, patterns and factors associated with hypertensive crises in Mulago hospital emergency department; a

Irene Nakalema¹, Mark Kaddumukasa¹, Jane Nakibuuka²

¹Department of Medicine, College of Health Sciences Makerere University, P. O. Box 7072 Kampala, Uganda.

African Health Sciences

|June 1, 2019

Insights

Hypertensive crises, including emergencies and urgencies, are common in Uganda, affecting 5.1% of admissions. Poor compliance with blood pressure medication is a key factor, often leading to acute stroke.

Area of Science:

Cardiology
Public Health
Neurology

Background:

Hypertension prevalence is rising in sub-Saharan Africa, posing a significant stroke risk.
Control of hypertension is often not emphasized in the region.
Hypertensive urgencies and emergencies in Uganda are not well-established.

Purpose of the Study:

To determine the prevalence of hypertensive crises in Uganda.
To identify factors associated with hypertensive urgencies and emergencies.
To investigate the common presentations of hypertensive emergencies.

Main Methods:

A cross-sectional study was conducted from November 2015 to February 2016.
Data collected via clinical examination and standardized questionnaires.
Logistic regression used to determine associations of demographic and clinical factors.

Main Results:

Hypertensive crises occurred in 5.1% of medical admissions.
Hypertensive emergencies constituted 67.5% of crises.
Poor self-reported compliance was strongly associated with hypertensive crises (OR: 52.4).
Acute stroke was the most frequent hypertensive emergency.

Conclusions:

Hypertensive emergencies are prevalent in Uganda.
Poor compliance with antihypertensive drugs is a significant factor.
Acute stroke is the most common presentation of hypertensive emergencies in this setting.

Read full analysis

Abstract

Background:

Hypertension is increasing in sub-Saharan Africa (SSA) and it's the single most important modifiable stroke risk factor, yet it's control is not routinely emphasized.The prevalence, pattern and factors associated with hypertensive urgencies and emergencies in Uganda is not well established. A cross-sectional study, was conducted between November 2015 and February 2016, using a complete clinical examination and pre-tested standardized questionnaire subjects were enrolled. The prevalence of hypertensive crises and associations of demographic and clinical factors determined using logistic regression.

Results:

The prevalence of hypertensive crises was 5.1%, (203/4000) of all admissions at the medical section of the accident and emergency ward of Mulago National Referral Hospital. The hypertensive urgencies and emergencies accounted for 32.5% and 67.5% respectively among study subjects with hypertension. Among those with hypertensive crises, 41.1% were aged 45-65 years and half were female. Self-reported compliance was significantly different between those with hypertensive crisis compared to non-hypertensive crisis with OR; (95% CI) 52.4; (24.5 - 111.7), p-value =<0.001. Acute stroke was the commonest hypertensive emergency.

Conclusion:

Hypertensive emergencies are common and significantly associated with poor compliance to prescribed anti-hypertensive drugs. Acute stroke is the commonest presentation in our setting.

Keywords:

Hypertensive crises factors associated prevalence

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