Prevalence of Hypertensive Emergency in Emergency Room of Rajavithi Hospital

Category:

Jaruboot Angsanakul, MD , rajavithi hospital
Sumitra Piyanuttapull, MD, MS , rajavithi hospital
Background: 

Hypertensive crisis is common among patients visiting emergency room (ER). Majority of these patients can be treated on an outpatient basis (hypertensive urgency). Other patients have acute end-organ damage and higher morbidity and mortality (hypertensive emergency). However, no study on the prevalence of hypertensive emergency in ER in Thailand was found. We aim to evaluate the prevalence and also potential predictors of hypertensive emergency.

Objective: 

Primary objectiveTo evaluate the incidence of hypertensive emergency in ER of Rajavithi hospital Secondary objectiveTo evaluate potential predictors of hypertensive emergency in patients with hypertensive crisis

Method: 

Medical records of patients who have systolic blood pressure > 180 mmHg and/or diastolic blood pressure > 120 mmHg were reviewed. The exclusion criteria include age < 18 years old, near death, a history of recent traumatic event, and a diagnosis of an acute ischemic stroke fast track. The patients were classified into two groups: hypertensive emergency and hypertensive urgency. The prevalence of hypertensive emergency and potential predictors of hypertensive emergency were analyzed.

Results: 

From June 1, 2013 to August 18, 2014, we found 307 patients with hypertensive crisis. 60 patients (19.54%) were classified as having hypertensive emergency. Prevalence rate of hypertensive emergency is 78.87 per 100,000 patients. Among several predictors for hypertensive emergency, these 3 predictors: dyspnea, dizziness and being transferred from outpatient department (OPD) to ER were significant. The odds ratios were 5.08 (95% Confidence interval (CI), 2.36 to 10.95; P < 0.001), 0.22 (95% CI, 0.08 to 0.60; P = 0.003) and 0.04 (95% CI, 0.01 to 0.19; P < 0.001), respectively.

Conclusion: 

Hypertensive emergency is common among patients with hypertensive crisis in ER. Dyspnea is a positive predictor of hypertensive emergency. Negative predictors include dizziness and being transferred from OPD to ER.