CLINICAL CHARACTERISTICS AND PARTICULARITIES OF HYPERTENSIVE PATIENTS OLDER THAN 90 YEARS ADMITTED TO AN EMERGENCY HOSPITAL

Abstract

Objective: The aim of the study was to assess the particularities and the comorbidities in hypertensive very elderly patients. Design and method: We performed a retrospective study on 119 patients admitted to a Clinical Emergency Hospital between July 2014 and December 2018. Results: Pacients in the study group were aged between 90 and 99 years, with an average age of 92 years. Gender distribution: 63% female and 37% male. 64.70% of the patients had hypertension, one of them with renal artery stenosis, all others with primary hypertension. In the subgroup of hypertensives patients 69% were female and 31% male. At admission 48% of patients had a high white blood cells count and in 30% of cases a urinary tract infection was proven. In 65% of cases was identified a nonspecific inflammatory syndrome and 48% of patients had a high erythrocyte sedimentation rate. As electrolytes imbalance we noticed hyponatremia in 19.5% of cases, hypokalemia in 28.6% and hyperkalemia in 2.6% of cases. 63.6% had anemia (87.75% mild anemia, 10.2% moderated anemia and 2.04% severe anemia). Chronic kidney disease evaluated by MDRD equation was encounterd in 90.9% of cases with the following staging: G2 30%, G3a 27.14%, G3b 25.71%, G4 14.28% and G5 2.8%. in 13% of cases the patients experienced a worsening of renal function. As comorbidities: atrial fibrillation in 39% of cases, heart failure in 76.62% (35.6% NYHA class II, 50.84% NYHA class III and 13.56% NYHA class IV), 46.75% respiratory failure, with hypoxemia - 13% of patients required non-invasive mechanical ventilation during hospitalization. 9% were diagnosed with chronic obstructive pulmonary disease. 23.4% had a history of stroke and also 23.4% of patients had diabetes mellitus. Regarding the nutrition state, 26% of patients were cachectic and 14.28% were overweight; 19.5% had bed sores. Conclusions: The most common comorbidities in hypertensive very elderly patients were chronic kidney disease, heart failure and hypoxemia. Almost all patients had primary hypertension, but we need to reconsider the medication doses and their side effects, the administration rate, the polypharmacy according the comorbidities.