Clinical and diagnostic features of uncontrolled hypertension and including hypertensive crisis

Abstract

Aim. To study clinical and diagnostic data, risk factors, the state of target organs damage (TOD) and prevalence of clinical associated conditions in patients with a hypertensive crisis and uncontrolled arterial hypertension.Materials and methods. The study included 297 patients hospitalized at the E.I. Chazov National Medical Research Center of Cardiology over the period from September 2019 to March 2022 with the presence of uncontrolled hypertension (blood pressure (BP) above 140/90 mm Hg while taking antihypertensive therapy). Patients were spread into two groups depending on the increase in the frequency of BP: group 1 (n=149) – uncontrolled hypertension with a hypertensive crisis (increase in BP 1 or more per week and/or the presence of severe clinical symptoms), and group 2 (n=148) – uncontrolled hypertension (increase in blood pressure more than 140/90 mm Hg less than 1 per week and/ or without severe clinical symptoms). The presence of risk factors in these groups was analyzed. At the baseline and after 12 months, the presence and severity of TOD (left ventricular mass index (LVMI), chronic kidney disease (CKD), severe retinopathy), history of/occurrence of clinical associated conditions were assessed.Results. There are significant elevated levels of uric acid, triglycerides, body mass index, heart rate, blood pressure indicators among the risk factors in the group of patients with hypertensive crisis. Patients in the group 1 showed higher rates of LVMI at the baseline and during follow-up for 12 months (baseline – 107±28 g/m2, after a year of follow-up 112±27 g/m2). The glomerular filtration rate (GFR) is lower in patients with hypertensive crisis (initially – 81.5±19.04 ml/min/1.73m2, after 12 months of observation 74.8±18.06 ml/min/1.73m2). There are significant differences in coronary artery disease, atherosclerosis of the brachiocephalic arteries, type 2 diabetes mellitus (DM 2) among clinical associated conditions. After 12 months of observation, acute cerebrovascular accident, coronary artery disease and diabetes occur more often in group 1.Conclusion. Uncontrolled hypertension with a hypertensive crisis manifestation is a release of hypertension associated with severe TOD and a high prevalence of clinical associated conditions.