Hospital and out‐of‐hospital mortality in 670 hypertensive emergencies and urgencies

Abstract

Long-term mortality in patients with acute severe hypertension is unclear. The authors aimed to compare short-term (hospital) and long-term (12 months) mortality in these patients. A total of 670 adults presenting for acute severe hypertension between January 1, 2015, and December 31, 2015, were included. A total of 57.5% were hypertensive emergencies and 66.1% were hospitalized: 98% and 23.2% of those with hypertensive emergencies and urgencies, respectively (P = .001). Hospital mortality was 7.9% and was significantly higher for hypertensive emergencies (12.5% vs 1.8%, P = .001). At 12 months, 106 patients died (29.4%), mainly from hypertensive emergencies (38.9% vs 8.9%, P = .001). Median survival was 14 days for neurovascular emergencies and 50 days for cardiovascular emergencies. Patients with hypertensive emergencies or urgencies had bad long-term prognosis. Short-term mortality is mainly caused by neurovascular emergencies, but cardiovascular emergencies are severe, with high mortality at 12 months. These results justify better follow-up and treatment for these patients.

Acute Treatment of Hypertensive Urgency

“…5 More recent studies suggest that the in-hospital and one-year mortality for those with hypertensive emergency are 13% and 39%, respectively. 6 These data demonstrate that patients with hypertensive emergency are at risk in both the short-and long-term.…”

“…The one-year mortality for those experiencing an episode of hypertensive urgency is approximately 9%. 6 Given the concerns about poor outcomes, it remains a common practice in many facilities to acutely lower the blood pressure in patients with hypertensive urgency. This is highlighted by recommendations of a commonly used point-of-care medical resource, which suggests that "potential legal ramifications partially motivate lowering the blood pressure over several hours."…”

Hypertensive crisis in modern guidelines: how to avoid mistakes in diagnosis and treatment. Based on the materials of the XXVI Russian National «Human and Medicine» Congress and the III Cardiology Summit

“…В то время как симптомы, говорящие в пользу поражения органов-мишеней, боль в груди и очаговая неврологическая симптоматика, отмечены только у 28% и 16% пациентов, соответственно [3]. [8]. По данным крупного мультицентрового исследования, включавшего пациентов с гипертоническим кризом, получавших внутривенную терапию, внутрибольничная смертность составила 6.9%, с последующей 90-дневной смертностью в 4,6%.…”

Hypertensive Krise und posteriores reversibles Enzephalopathie-Syndrom (PRES)

“…▪ Hypertensive Krisen treten meist bei Werten > 180/120 mmHg, bei Präeklampsie aber auch früher auf. ▪ Patienten mit hypertensiven Krisen sind nicht nur ursachenabhängig akut vital gefährdet, sondern auch die 12-Monats-Mortalität nach hypertensiven Krisen (nicht nur Notfällen) ist mit rund 30 % erheblich erhöht [61]. ▪ Ohne akute Endorganschäden (hypertensive urgency) ist eine orale Behandlung zur schrittweisen RR-Normalisierung über 24-48 Stunden ausreichend.…”