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Hypertensive urgencies and emergencies. Prevalence and clinical presentation
B Zampaglione1, C Pascale, M Marchisio
1Ward of Internal Medicine II, Martini Hospital, Turin, Italy.
Insights
Hypertensive crises, including urgencies and emergencies, are common in emergency departments. These conditions present differently and can lead to severe end-organ damage like cerebral infarction and pulmonary edema.
Area of Science:
- Emergency Medicine
- Cardiology
- Neurology
Background:
- Hypertensive urgencies and emergencies are frequent in emergency departments but their clinical characteristics and prevalence are not well understood.
- Understanding these conditions is crucial for timely diagnosis and management to prevent end-organ damage.
Purpose of the Study:
- To determine the prevalence of hypertensive crises (urgencies and emergencies) in an emergency department over 12 months.
- To analyze the frequency and clinical presentation of end-organ damage within 24 hours of presentation for hypertensive crises.
Main Methods:
- Prospective observational study over 12 months in an emergency department.
- Data collection on patient demographics, clinical signs, and diagnosis of hypertensive crises (urgencies and emergencies).
- Assessment of end-organ damage and clinical manifestations within the first 24 hours.
Main Results:
- Hypertensive crises constituted over 25% of all medical urgencies-emergencies, with 76% being urgencies and 24% emergencies.
- Common presentations included headache and epistaxis for urgencies, and chest pain, dyspnea, and neurological deficits for emergencies.
- End-organ damage in emergencies most frequently involved cerebral infarction (24%), acute pulmonary edema (23%), and hypertensive encephalopathy (16%).
- Patients with hypertensive emergencies were older and had higher diastolic blood pressure compared to those with urgencies.
- Undiagnosed hypertension was more prevalent in hypertensive urgencies (28%) than emergencies (8%).
Conclusions:
- Hypertensive urgencies and emergencies are common and distinct clinical events in emergency departments.
- Cerebral infarction and acute pulmonary edema are the most significant types of end-organ damage associated with hypertensive emergencies.
- Recognizing the differing clinical patterns is essential for effective management of hypertensive crises.
Abstract:
The prevalence and clinical picture of hypertensive urgencies and emergencies in an emergency department are poorly known. The aim of the present study was to evaluate the prevalence of hypertensive crises (urgencies and emergencies) in an emergency department during 12 months of observation and the frequency of end-organ damage with related clinical pictures during the first 24 hours after presentation. Hypertensive crises (76% urgencies, 24% emergencies) represented more than one fourth of all medical urgencies-emergencies. The most frequent signs of presentation were headache (22%), epistaxis (17%), faintness, and psychomotor agitation (10%) in hypertensive urgencies and chest pain (27%), dyspnea (22%), and neurological deficit (21%) in hypertensive emergencies. Types of end-organ damage associated with hypertensive emergencies included cerebral infarction (24%), acute pulmonary edema (23%), and hypertensive encephalopathy (16%) as well as cerebral hemorrhage, which accounted for only 4.5%. Age (67 +/- 16 versus 60 +/- 14 years [mean +/- SD], P < .001) and diastolic blood pressure (130 +/- 15 versus 126 +/- 10 mm Hg, P < .002) were higher in hypertensive emergencies than urgencies. Hypertension that was unknown at presentation was present in 8% of hypertensive emergencies and 28% of hypertensive urgencies. In conclusion hypertensive urgencies and emergencies are common events in the emergency department and differ in their clinical patterns of presentation. Cerebral infarction and acute pulmonary edema are the most frequent types of end-organ damage in hypertensive emergencies.