Abstract
Background: A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders. Methods: Data from 718 patients presenting to the emergency department of the “Città della Salute e della Scienza” Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed. Results: A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity. Conclusion: Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.
Highlights
Hypertensive emergencies are characterized by an acute and severe blood pressure (BP) rise (>180/110 mm/Hg) with associated acute hypertension-mediated target organ damage
A total of 79 (11%) patients in our population were diagnosed with hypertensive emergencies: 28 (35%) had acute heart failure, 17 (22%) had transitory ischemic attack, 14 (18%) had ischemic stroke, 12 (15%) had acute coronary syndrome, 7 (9%) had hemorrhagic stroke, and 1 (1%) had acute aortic dissection
Patients with hypertensive emergencies were older (73.2 ± vs. 69.5 ± years, p = 0.03) and had higher prevalence of coronary artery disease (24% vs. 11%, p < 0.01) and chronic heart failure (6% vs. 2%, p = 0.04) compared to those with uncontrolled hypertension
Summary
Hypertensive emergencies are characterized by an acute and severe blood pressure (BP) rise (>180/110 mm/Hg) with associated acute hypertension-mediated target organ damage (aHMOD). Limited scientific evidence is currently available on the role of symptoms in both diagnosis and management of acute hypertensive disorders. A hierarchical strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to screen patients with suspected hypertensive emergencies [1], but the accuracy of this symptom-based approach has not been validated. The aim of our study is to assess the accuracy of a symptoms-based diagnostic strategy in distinguishing patients with hypertensive emergencies from those with severe uncontrolled hypertension. A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. Poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders.
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