HYPERTENSIVE CRISIS AT THE EMERGENCY DEPARTMENT OF A CENTRAL HOSPITAL

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Objective: Hypertension is a well-established cardiovascular risk factor. Its low control can progress to a hypertensive crisis (HC) and the emergency department (ED) is the first point of contact of these patients. This study’s aim was analyzing the profile and management of the patients presenting with HC at the ED of a central hospital in Portugal. Design and method: This study is descriptive and retrospective in nature, encompassing three months of adult patients admittances to the ED with symptomatic or asymptomatic hypertension (337 in total). We defined hypertension as blood pressure (BP) greater than or equal to 140/90mmHg and HC as BP greater than or equal to 180/110mmHg. Results: Patients presenting to the ED with elevated blood pressure were predominantly women (65%) aged over 60 years. BP values compatible with HC were found in 40,4% of cases. Hypertension was unknown to 13,3% of patients. Despite having previously diagnosed hypertension, 8,5% were not receiving any medication. At admission, headache (45,1%), nausea and dizziness (19,3%), and chest pain (17,2%) were the most frequent symptoms. About 18% were asymptomatic. 71% of patients with elevated BP were receiving treatment with antihypertensive drugs. All off those presenting with HC received pharmacological treatment. Angiotensin-converting enzyme inhibitor was the most used class (75%), followed by benzodiazepines (~52%). Regarding the evolution of the blood pressure in the ED, the majority of patients had controlled or lower blood pressure at the time of discharge. The outpatient antihypertensive medication was adjusted in 25,8% of cases. Adding another drug was the most common strategy (23%), followed by initiating a fixed drug combination (18,4%) or starting therapy with a single drug (15%). At a one-year follow-up, most of patients (90,5%) were not readmitted to the ED due to hypertension. Conclusions: Hypertension is still a common cause of admission to the ED, despite only 40% of cases representing real HC. The lack of uniform management at the ED, or after discharge, further demonstrates a missed opportunity to prevent future cardiovascular morbidity/mortality.

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