Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P
Hypertensive urgencies and emergencies: prevalence and
(Jan) 27:144-147 1996
Hypertension severe enough to require urgent or emergent treatment is not
unusual in the emergency room setting. This study sought to quantify the
prevalence, clinical presentations, and end-organ injuries in their own
emergency department. Using the criteria of the National Committee on
Detection, Evaluation and Treatment of High Blood Pressure, the
investigators found that
hypertensive crisis, diastolic BP greater than 120 mm Hg, had a prevalence
percent in the population presenting for emergency medical treatment. Of
these 26% showed signs of end-organ injury, which is the operational
definition of hypertensive emergency. Among those patients with
emergencies 24% presented with cerebral infarction, 23% with pulmonary edema
and 16% with hypertensive encephalopathy. Remarkably only 4.5% of patients
with hypertensive emergencies had cerebral hemorrhage.
In the remainig 74%, there was no evidence of end-organ injury, and these
patients were described as hypertensive urgencies. In this group the
symptom was headache in 22%, epistaxis in 17%, and 10% had either faintness
or psychomotor agitation.
Overall 8% and 28% of those with hypertensive emergencies and urgencies,
respectively had no known prior history of hypertension.
Comment: The nosology of hypertensive crises is necessarily
and the present
study very adequately describes the clinical presentation of this group of
patients. The findings in this Italian population,
described as all white, may not be applicable to other populations.
(Greg Cowell, M.D, Chicago, IL)