Clinical characteristics, practice patterns, and outcomes of patients with acute severe hypertension visiting the emergency department

Abstract

Objectives: Data regarding acute severe hypertension, a life-threatening condition encountered in the emergency department, are limited. We aimed to identify the characteristics, practice patterns, and outcomes of patients with acute severe hypertension in the emergency department.Methods: This cross-sectional study at a tertiary referral centre included patients aged at least 18 years who were admitted to the emergency department between January 2016 and December 2019 for acute severe hypertension, which was defined as SBP at least 180 mmHg and/or DBP at least 100 mmHg.Results: Of 172 105 patients who visited the emergency department, 10 219 (5.9%) had acute severe hypertension. Of them, 2506 (24.5%) patients had acute hypertensionmediated organ damage (HMOD), and these patients had more cardiovascular risk factors than did patients without HMOD. Additionally, 4137 (40.5%) patients were admitted, and nine (0.1%) died in the emergency department. The overall 3-month, 1-year, and 3-year mortality rates were 4.8, 8.8, and 13.9%, respectively. In patients with HMOD, the 1-year mortality rate was 26.9%, and patients lost to follow-up had a significantly higher 1year mortality rate than those who were followed up (21.3 vs. 10.5%, respectively, P < 0.001). Conclusion:The mortality rate in patients with acute severe hypertension in the emergency department is high, especially in patients with HMOD. Evaluation of HMOD, investigating the underlying causes, and adequate followup are mandatory to improve the outcomes in these patients. This study emphasizes the need for diseasespecific guidelines that include detailed acute treatment strategies and follow-up management for acute severe hypertension.

Impact of underweight on 3-year all-cause mortality in patients with acute severe hypertension: a retrospective cohort study

“…In particular, acute and severe BP elevations due to uncontrolled hypertension are serious problems commonly encountered in patients visiting the emergency department (ED). According to our previous study, patients with acute severe hypertension, which was defined as systolic blood pressure (SBP) ≥ 180 mmHg or diastolic blood pressure (DBP) ≥ 100 mmHg, accounted for 59 out of 1000 ED visits at a single center and showed poor clinical outcomes, with a 1-year mortality rate of 8.8% and a 3-year mortality rate of 13.9% 4 .…”

Clinical Characteristics and Predictors of All-Cause Mortality in Patients with Hypertensive Urgency at an Emergency Department

“…Our study showed a much higher mortality rate in patients with hypertensive urgency than expected, reflecting the recent real-world practice data. We previously reported that despite a significantly lower long-term mortality in patients without acute HMOD than in patients with acute HMOD, the values were still very high, with 6.8% and 12.1% after 1 year and 3 years, respectively [7]. In addition, the present study showed that 26.8% of patients with hypertensive urgency were hospitalized during the index visit, and the overall ED revisit and readmission rates were higher than expected: 10.6% and 7.2% within 1 month and 17.7% and 9.9% within 3 months, respectively.…”

“…Patients with acute trauma or who only needed a medical certificate were excluded; if they visited the ED multiple times, only data from the first visit were included. Patients with hypertensive crisis were further classified based on the presence of acute target organ damage, such as hypertensive encephalopathy, cerebral infarction, intracerebral hemorrhage, retinopathy, acute heart failure, acute coronary syndrome, acute renal failure, and aortic dissection, which was diagnosed based on clinical data and diagnostic tests, such as blood chemistry analysis, eye fundus examination, 12-lead electrocardiography (ECG), chest radiography, echocardiography, computed tomography (CT), and magnetic resonance imaging [7]. Laboratory data included complete blood count, blood biochemical test findings (levels of electrolytes, renal and liver function tests, and blood glucose), routine urinalysis results, and blood levels of C-reactive protein, D-dimer, brain natriuretic peptide, and troponin-I.…”

Clinical implications of cardiac troponin-I in patients with hypertensive crisis visiting the emergency department

“…Patients with hypertensive crisis were further divided into hypertensive emergency and hypertensive urgency according to the presence or absence of acute HMOD. Acute HMOD was defined by the presence of one of the following conditions: hypertensive encephalopathy, cerebral infarction, intracerebral haemorrhage, retinopathy, acute heart failure, acute coronary syndrome, acute renal failure and aortic dissection [ 8 ].…”

“…Data were collected using the electronic medical records. The detailed study design and definitions of comorbidities in our study have been published previously [ 8 , 9 ]. Briefly, baseline data for enrolled patients were obtained at the index visit of ED, and events during the follow-up periods were obtained until death from any cause or the end of the study (March 2021).…”