Profile of patients with hypertensive urgency and emergency presenting to an urban emergency department of a tertiary referral hospital in Tanzania

Abstract

BackgroundHypertensive crises are clinical syndromes grouped as hypertensive urgency and emergency, which occur as complications of untreated or inadequately treated hypertension. Emergency departments across the world are the first points of contact for these patients. There is a paucity of data on patients in hypertensive crises presenting to emergency departments in Tanzania. We aimed to describe the profile and outcome of patients with hypertensive crisis presenting to the Emergency Department of Muhimbili National Hospital in Tanzania.MethodsThis was a descriptive cohort study of adult patients aged 18 years and above presenting to the emergency department with hypertensive urgency or emergency over a four-month period. Trained researchers used a structured data sheet to document demographic information, clinical presentation, management and outcome. Descriptive statistics with 95% confidence intervals (CIs) are presented as well as comparisons between the groups with hypertensive urgency vs. emergency.ResultsWe screened 8002 patients and enrolled 203 (2.5%). The median age was 55 (interquartile range 45–67 years) and 51.7% were females. Overall 138 (68%) had hypertensive emergency; and 65 (32%) had hypertensive urgency, for an overall rate of 1.7% (95% CI: 1.5 to 2.0%) and 0.81% (95% CI: 0.63 to 1.0%), respectively. Altered mental status was the most common presenting symptom in hypertensive emergency [74 (53.6%)]; low Glasgow Coma Scale was the most common physical finding [61 (44.2%)]; and cerebrovascular accident was the most common final diagnosis [63 (31%)]. One hundred twelve patients with hypertensive emergency (81.2%) were admitted and three died in the emergency department, while 24 patients with hypertensive urgency (36.9%) were admitted and none died in the emergency department. In-hospital mortality rates for hypertensive emergency and urgency were 37 (26.8%) and 2 (3.1%), respectively.ConclusionIn our cohort of adult patients with elevated blood pressure, hypertensive crisis was associated with substantial morbidity and mortality, with the most vulnerable being those with hypertensive emergency. Further research is required to determine the aetiology, pathophysiology and the most appropriate strategies for prevention and management of hypertensive crisis.

<p>Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study</p>

“…7 The study done from Tanzania revealed that among hypertensive patients admitted to the emergency department about 68% of patients developed HE. 8 Similarly, Papadopoulos and his co-authors found that HE accounted 24% of hypertensive crisis cases. Moreover, the study revealed that cerebral infarction (24%), acute pulmonary edema (23%), hypertensive encephalopathy (16%), and cerebral hemorrhage (4.5%) were the involved target organ damages.…”

The capacity of primary health care centers in Jordan to manage hypertension: areas for improvement

“…Furthermore, the study showed that the majority of physicians were able to refer hypertensive emergency cases and approximately half of health centers refer hypertensive patients for a second opinion or consultations. These findings may be explained by the fact that majority of health centers have poorly equipped emergency departments and this lack of properly equipped facilities is a barrier to early intervention and management [31]. In fact, emergency departments are considered potential sites for the screening and referral of hypertensive patients [32].…”

Hypertensive Emergencies in the Department of Cardiology at the Teaching University Hospital of Brazzaville (Republic of the Congo): Preliminary Study

“…Mortality at one year remains high, 26.8% for Shao and 79% for Aronow [7] [13]. These deaths are attributed to the failure of the target organs, namely the heart, brain and kidney during hypertensive crises.…”

“…Indeed, Maweni reported that 46% of hypertensive emergencies revealed hypertension in black patients [6]. Hypertensive urgency is a serious disease, because of its high mortality with a decline at one year, estimated at 26.8% according to Shao [7]. In Brazzaville, hypertension is often revealed by complications, due to the delay of diagnosis and poor care, and hypertensive emergencies are dominated by stroke [4]…”