Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department

Abstract

Objective: To assess patients with hypertensive crisis, classified as urgency, emergency or pseudocrisis, and identify the associated variables. Methods: We evaluated a total of 508 patients (57% women; 56.3±13.8 years old) with hypertensive crisis (diastolic blood pressure of 120mmHg), aged 18 years or over, seen at the emergency department of a public general hospital. Results: The prevalence of hypertensive crises was 6/1,000; in that, 71.7% presented hypertensive urgency, 19.1% hypertensive emergency, and 9.2% hypertensive pseudocrisis. In the multinominal logistic regression, pseudocrisis and urgency conditions were compared to hypertensive emergency. Therefore, the presence of pain (OR: 55.58; 95%CI: 10.55-292.74) except chest pain and headache, and emotional problems (OR: 17.13; 95%CI: 2.80-104.87) increased the likelihood of hypertensive pseudocrisis. Age >60 years (OR: 0,32; 95%CI: 0.10-0.96) and neurologic problems (OR: 1.5.10 -8 ; 95%CI: 1.5.10 -8 -1.5.10 -8 ) protected against hypertensive pseudocrisis. The comparison of hypertensive urgency with hypertensive emergency showed that age >60 years (OR: 0.50; 95%CI: 0.27-0.92), neurologic (OR: 0.09; 95%CI: 0.04-0.18) and emotional problems (OR: 0.06; 95%CI: 4.7.10 -3 -0.79) protected against hypertensive urgency. Moreover, only headache (OR: 14.28; 95%CI: 3.32-61.47) increased the likelihood of hypertensive urgency. Conclusion: Advanced age and neurological problems were associated to hypertensive emergency. Headache was associated with hypertensive urgency. Pain and emotional problems were associated with hypertensive pseudocrisis. Our results can contribute to identifying patients with hypertensive crisis who seek emergency services.

Diretrizes Brasileiras de Hipertensão Arterial – 2020

“…[735][736][737] É condição clínica de incidência decrescente nas últimas décadas. [738][739][740]…”

Inflammatory Cytokines are Associated to Lower Glomerular Filtration Rate in Patients with Hypertensive Emergency

“…This study shows elevated levels of proinflammatory cytokines associated to reduced renal function in individuals suffering from acute hypertensive events. In spite of HC being an event common in the clinical emergency department [14][15][16][17], its pathophysiology continues unclear. Generally, this process is started by an imbalance between cardiac outcome and peripheral vascular resistance with participation of several mechanisms, including renal sodium handling, systemic vascular responses, cardiac output, and sympathetic outflow [4,5].…”

Alprazolam Una Alternativa Terapéutica en Urgencia Hipertensiva

“…En cuanto al número de pacientes con diagnóstico previo de hipertensión arterial el 76% de los pacientes lo tenían, cabe destacar que en el grupo B había una mayor proporción de pacientes sin diagnostico que representaba el 28.5 % (n=16) en comparación con el grupo A con un 12% (n=5), estos hallazgos son comparables con el estudio de Pierin (16) JF et al donde el 88% de los pacientes con crisis de hipertensiva reportaron antecedentes conocidos de HTA.…”