Abstract P108: Standardised and Interdisciplinary Management of Hypertensive Urgency Improve Patients Medicalcare and Follow Up

Abstract

Acute severe hypertension (ASH) includes low risk to life threatening events and is defined as sustained blood pressure (BP) > 180/100 mmHg. There are 2 types of ASH: hypertensive emergency (HE), and hypertensive urgency (HU). The difference is the presence (HE) or absence (HU) of acute target organ damage (TOD). Unassisted HU can evolve to HE. More than 80 % of ASH was HU with inadequate managment. The aim of the present study was to standardize the HU management based on interdisciplinary team work and to differenciate low from high risk HU. We studied 193 patients with ASH (64±12,6 years old, 117 women and 76 men). HU evaluation consisted of physical exam, ECG, chest X-Ray, full blood and urine work, retinal exam. Patient education and patient’s follow-up inmediately after acute presentation were also included. We identified 2 HU populations: High-risk HU (previous hypertensive patients or with chronic TOD), and low-risk HU (no TOD). The latter would rest for 1 h until BP <160/100 mmHg. High-risk HU typically present 4 th sound, ventricular hypertrophy, creatinine>1.5 mg/dL or “arterial-venous” crosses in retinal exam, and will receive pharmacological treatment (orally labetalol 200 mg). We monitored patients for 2 h after the drug was administered, and if BP <160/100, patients were sent home, to keep rest, follow a low-sodium diet and be reevaluated 24 h later. If BP >160/100 mmHg patients will receive a 2 nd dose of labetalol. The study revealed that 41 of 193 pacients (22%) were not diagnosed with high BP before, and chronic TOD was identified in 19 of them. From 152 hypertensive patients, only 31 (20%) were adequately managed and treated. The most frequent cause that triggered HU was the dietary transgression (excessive salt ingestion). In conclusion, standardized assessment and management of HU revealed that a high percentage of patients with high BP lack adequate diagnosis and/or management, and end up developing HU. Implementation of resting allowed us to achieve the goal of BP<160/100 in low-risk HU patients. High-risk HU patients were best and safe treated with orally labetalol. The new guideline also secured a medical follow-up of all HU patients, decreasing their fall-off of the medical system (<10%) and improving their long-term medical management.