HDCN Article Review/Hyperlink

Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P

Hypertensive urgencies and emergencies: prevalence and clinical presentation

Hypertension (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 of 3 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 hypertensive 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 presenting 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 descriptive, 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)