Title:Clinical Profile of Patients with Hypertensive Emergency Referred to a
Tertiary Hospital in the Western Cape Province of South Africa
Volume: 19
Issue: 3
Author(s): Mohammed A. Talle*, Anton F. Doubell, Pieter-Paul S. Robbertse, Sa'ad Lahri and Philip G. Herbst
Affiliation:
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Health Sciences Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri and University of Maiduguri Teaching Hospital, Maiduguri 600004, Nigeria
Keywords:
Hypertensive crisis, hypertensive emergency, hypertensive urgency, clinical profile, lactate dehydrogenase, cardiac troponin, brain natriuretic peptide, tertiary hospital.
Abstract:
Background: Despite advances in managing hypertension, hypertensive emergencies remain
a common indication for emergency room visits. Our study aimed to determine the clinical profile of
patients referred with hypertensive emergencies.
Methods: We conducted an observational study involving patients aged ≥18 years referred with hypertensive
crisis. A diagnosis of hypertensive emergencies was based on a systolic blood pressure (BP)
≥180 mmHg and/or a diastolic BP ≥110 mmHg, with acute hypertension-mediated organ damage (aHMOD).
Patients without evidence of aHMOD were considered hypertensive urgencies. Hypertensive
disorders of pregnancy and unconscious patients were excluded from the study.
Results: Eighty-two patients were included, comprising 66 (80.5%) with hypertensive emergencies and
16 (19.5%) with hypertensive urgencies. The mean age of patients with hypertensive emergencies was
47.9 (13.2) years, and 66.7% were males. Age, systolic BP, and duration of hypertension were similar in
the hypertensive crisis cohort. Most patients with hypertensive emergencies reported nonadherence to
medication (78%) or presented de novo without a prior diagnosis of hypertension (36%). Cardiac aHMOD
(acute pulmonary edema and myocardial infarction) occurred in 66%, while neurological emergencies
(intracranial hemorrhage, ischemic stroke, and hypertensive encephalopathy) occurred in
33.3%. Lactate dehydrogenase (LDH) (P < 0.001), NT-proBNP (P=0.024), and cardiac troponin
(P<0.001) were higher in hypertensive emergencies compared to urgencies. LDH did not differ in the
subtypes of hypertensive emergencies.
Conclusion: Cardiovascular and neurological emergencies are the most common hypertensive emergencies.
Most patients reported nonadherence to medication or presented de novo without a prior diagnosis
of hypertension.
