Abstract 15577: Clinical Outcomes in Hypertensive Emergency: A Systematic Review and Meta-Analysis

Abstract

Introduction: Despite the increasing rate of hypertensive emergency (elevated blood pressure with acute target organ damage) presentations in the emergency department (ED), subsequent morbidity and mortality data to support clinical decision making remains scarce. We aim to study the prevalence and prognosis of hypertensive emergencies and hypertension mediated organ damage (HMOD) in patients presenting to the ED. Methods: PubMed and Scopus were queried from their inception through the mid of November 2021. Studies were included if they reported the prevalence or prognosis of hypertensive emergencies in patients presenting to the ED. Data from each study was arcsine-transformed and pooled using a random-effects model. Results: Fourteen studies (n = 4370 patients) were included in our analysis. Pooled analysis demonstrates that the prevalence of hypertensive emergencies was 0.5% (95% CI: 0.40 - 0.60) in patients presenting to ED. Ischemic stroke 28.1% (95% CI: 18.7 - 38.6), was the most prevalent HMOD, followed by pulmonary edema/acute heart failure 24.1%, (95% CI: 19.0 - 29.7, hemorrhagic stroke 14.6%, (95% CI: 9.9 - 20.0), acute coronary syndrome 10.8%, (95% CI: 7.3 - 14.8), renal failure 8.0%, (95% CI: 2.9 - 15.5), subarachnoid hemorrhage 6.9%, (95% CI: 3.9 - 10.7), encephalopathy 6.1%, (95% CI: 1.9 - 12.4), and the least prevalent was aortic dissection 1.8%, (95% CI: 1.1 - 2.8) ( Figure ). Mortality rate among patients admitted to the hospital due to hypertensive emergency was 9.9% (CI: 1.4 - 24.6). Conclusions: Our findings demonstrate substantial morbidity and mortality amongst patients presenting to the ED with hypertensive emergency. Results of studies may help clinicians identify organs at highest risk of damage in patients with hypertensive emergency, aiding the work-up and therefore helping curb the burden of this disease.