Abstract P297: Hypertensive Crisis in an Inner-City Population: A Retrospective Case Control Study

Abstract

Hypertensive crisis (HTNC) is a potentially life-threatening condition that can develop de novo or as a complication of hypertension. HTNC is characterized by a severe and an acute increase in blood pressure (BP) ≥ 180/120 mmHg, which may progress to end organ damage (EOD), and premature death. HTNC is divided into hypertensive emergency (HTNE), in which there is evidence of EOD, and hypertensive urgency (HTNU) with no EOD. We conducted a 3-year retrospective case controlled study, to determine the prevalence and the risk factors for HTNE and HTNU in an inner city population. Cases (1784) were adult patients visiting the ER with a BP ≥ 200/120 mmHg. Controls had a diagnosis of HTN defined by a BP >140/90, but < 200/120 mmHg. Controls were matched 1:1 for age, gender and race using the SAS program. The total population of subjects with a diagnosis of hypertension was 15631. African Americans accounted for 89% (1585/1784) of the cases, other races for 9% (159/1784) and Caucasians for 2% (40/1784). The prevalence of HTNC was 11.4 % (1784/15631) and HTNE 3.2 % (505/15631). Twenty eight percent (28%) of the cases (505/1784) had EOD. Cases had significantly increased odds of developing the following EOD: acute kidney injury (OR 1.54, p=0.022), acute or worsening congestive heart failure (OR 4.91, p<0.0001), non ST elevation myocardial infarction (OR 2.39, p<0.0001), ischemic stroke (OR 3.27, p<0.0001), hemorrhagic stroke (OR 4.55, p<0.001). The predictors for EOD were: age > 65, male gender, anemia, chronic kidney disease and a history of stroke and cardiovascular comorbidities (hyperlipidemia, coronary artery disease, congestive heart failure). Insurance status and access to primary care were not associated with an increased odds of EOD. The study highlights the high morbidity of poorly controlled HTN, and the disparity in the prevalence of HTNC in the African American community, which is 5 times the national average.