Troponin, ECG Changes, and Blood Pressure in Hypertensive Emergencies

Hypertensive emergencies, defined as an abrupt and severe elevation in blood pressure with acute target-organ damage, represent a critical condition with substantial morbidity and mortality. Cardiac involvement, particularly myocardial injury, is common but often under-recognized in acute settings. Measurement of cardiac troponin and electrocardiographic (ECG) assessment is essential for identifying myocardial damage, guiding early intervention, and prognostic evaluation in patients with hypertensive emergencies. This study aimed to evaluate the relationship between cardiac troponin levels, ECG changes, and blood pressure severity in predicting outcomes, including mortality, among patients with hypertensive emergencies admitted to the emergency department.

A prospective observational study at a tertiary care center in Eastern India enrolled 140 patients with systolic blood pressure (SBP) ≥180 mmHg and diastolic blood pressure (DBP) ≥110 mmHg with target-organ damage. Exclusion criteria included trauma, malignancy, and infection. All underwent detailed clinical assessment, ECG within 30 min, and high-sensitivity troponin I testing. Analyses included chi-square, Kruskal-Wallis, and multivariate logistic regression; p<0.05 was considered significant.

Mean age was 50.21±16.52 years; 76 (54.29%) patients were male, and 84 (60%) patients were aged >45 years. Common symptoms were giddiness in 73 (52.14%) patients, nausea/vomiting in 67 (47.86%) patients, and headache in 55 (39.29%) patients. Altered mental status was noted in 38 (27.14%) patients and breathlessness in 39 (27.86%) patients and were strongly associated with mortality (p<0.001 and p=0.002). Elevated troponin (>150 pg/mL) occurred in 37 (26.43%) cases and independently predicted mortality (OR=4.79). ECG abnormalities occurred in 88 (62.86%) cases, mainly left ventricular hypertrophy in 97 (69.28%) cases. Mortality was noted in 25 (17.86%) cases, with 17 (12.14%) after 72 h.

Elevated troponin, ECG abnormalities, altered mental status, and breathlessness are strong mortality predictors in hypertensive emergencies, warranting early detection for improved outcomes.