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Hypertensive crisis and its predictors in Africa: Systematic review and meta-analysis, 2024
Ousman Adal1, Natnael Kebede2, Amare Mebrat Delie3
1Department of Emergency and Critical Care Nursing Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar City, Ethiopia.
Insights
Hypertensive crises affect 9.09% of patients, particularly those with a history of hypertension, comorbidities, or advanced age. Poor medication adherence and alcohol misuse are significant risk factors, necessitating targeted healthcare strategies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Hypertensive crises are a major cause of emergency department visits.
- A significant proportion of patients with hypertensive crises have a history of hypertension.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence of hypertensive crises.
- To identify risk factors associated with hypertensive crises in individuals with known or unknown hypertension history.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched multiple databases (PubMed, Embase, Scopus, etc.).
- Used random-effects DerSimonian-Laird model for meta-analysis.
Main Results:
- The pooled prevalence of hypertensive crisis was 9.09% (95% CI: 7.41%–10.77%).
- Risk factors included poor medication adherence, comorbidities, history of hypertension, age >65, and excessive alcohol intake.
Conclusions:
- Hypertensive crises are highly prevalent among hospital-presenting patients in Africa.
- Targeted interventions addressing medication adherence, comorbidities, and lifestyle factors are crucial for improving patient outcomes.
Introduction:
Hypertensive crises are a leading cause of visits to emergency departments, carrying grave health implications. A significant number of patients presenting with these crises have a known history of hypertension.
Objective:
The aim of this systematic review and meta-analysis is to examine the combined prevalence of hypertensive crises among individuals with either a history of hypertension or unknown status (newly diagnosed with a hypertensive crisis).
Methods:
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the Prospective Register of Systematic Reviews (PROSPERO). Research databases, including PubMed, Embase, Scopus, Africa Index Medicus, Science Direct, HINARI, and Google Scholar, were systematically searched. Study quality was evaluated using the Newcastle-Ottawa Scale, while publication bias was explored through Egger's regression test, funnel plots, and sensitivity analyses. Data collection adhered to the Joanna Briggs Institute (JBI) format. Meta-analysis was performed using STATA version 17, employing the random-effects DerSimonian-Laird model.
Results:
Amongst the 15 studies analyzed, the application of the random-effects DerSimonian-Laird statistical model indicated that the prevalence of hypertensive crisis was determined to be 9.09 %, with a 95 % confidence interval (CI) ranging from 7.41 % to 10.77 %. Factors such as poor medication adherence (POR 5.00; 95 % CI: 3.61, 6.93), patients with comorbidities (POR 4.73; 95 % CI: 3.29, 6.80), patients with a history of hypertension (POR 5.64; 95 % CI: 4.57, 6.94), patients aged >65 (POR 2.77; 95 % CI: 2.16, 6.59), and excessive alcohol intake (POR 5.01; 95 % CI: 3.82, 6.58) were associated with higher odds of hypertensive crisis.
Conclusion:
The findings indicate a markedly higher incidence of hypertensive crisis among hospital-presenting patients in Africa. Factors such as medication non-adherence, co-existing comorbidities, historical hypertension, being over 65, and alcohol misuse significantly contribute to this condition. These insights call for a comprehensive healthcare strategy that targets both the management of hypertension and its complications, aiming to improve the overall health outcomes of affected patients.
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