Clinical Characteristics and Predictors of All-Cause Mortality in Patients with Hypertensive Urgency at an Emergency Department.

Jeong-Hun Shin,Jun Hyeok Lee,Byung Sik Kim,Jinho Shin,Hyun-Jin Kim,Young-Hyo Lim,Jin-Kyu Park,Minhyung Lyu

doi:10.3390/jcm10194314

Abstract

Hypertensive urgency is characterized by an acute increase in blood pressure without acute target organ damage, which is considered to be managed with close outpatient follow-up. However, limited data are available on the prognosis of these cases in emergency departments. We investigated the characteristics and predictors of all-cause mortality in Korean emergency patients with hypertensive urgency. This cross-sectional study included patients aged ≥18 years who visited an emergency tertiary referral center between January 2016 and December 2019 for hypertensive urgency, which was defined as a systolic blood pressure of ≥180 mmHg and a diastolic blood pressure of ≥110 mmHg, or both, without acute target organ damage. The 1 and 3 year all-cause mortality rates were 6.8% and 12.1%, respectively. The incidence of emergency department revisits and readmission after 3 months and 1 year was significantly higher in non-survivors than in survivors. In a multivariate analysis, age ≥ 60 years (hazard ratio (HR), 16.66; 95% CI, 6.20–44.80; p < 0.001), male sex (HR, 1.54; 95% CI, 1.22–1.94; p < 0.001), history of chronic kidney disease (HR, 2.18; 95% CI, 1.53–3.09; p < 0.001), and proteinuria (HR, 1.94; 95% CI, 1.53–2.48; p < 0.001) were independent predictors of 3 year all-cause mortality. The all-cause mortality rate of hypertensive urgency remains high despite the increased utilization of antihypertensive medications. Old age, male sex, history of chronic kidney disease, and proteinuria were poor prognostic factors for all-cause mortality in patients with hypertensive urgency.

Highlights

Introduction iationsPhysicians in emergency departments (EDs) frequently encounter patients with hypertensive crisis, which is an acute and severe rise in blood pressure (BP) presenting with highly heterogeneous profiles ranging from the absence of symptoms to life-threatening acute target organ damage [1,2,3]
Patients with hypertensive crisis were further classified based on the presence of acute target organ damage, such as hypertensive encephalopathy, cerebral infarction, intracerebral hemorrhage, retinopathy, acute heart failure, acute coronary syndrome, acute renal failure, and aortic dissection, which was diagnosed based on clinical data and diagnostic tests, such as blood chemistry analysis, eye fundus examination, 12-lead electrocardiography (ECG), chest radiography, echocardiography, computed tomography (CT), and magnetic resonance imaging [7]
Additional analysis for 1 year all-cause mortality showed similar results, that age ≥ 60 years (HR, 18.89; 95% CI, 4.66–76.49; p < 0.001), male sex (HR, 1.44; 95% CI, 1.07–1.95; p < 0.001), and proteinuria (HR, 1.89; 95% CI, 1.53–2.48; p < 0.001) were independent predictors (Supplementary Table S1)

Summary

Introduction

Physicians in emergency departments (EDs) frequently encounter patients with hypertensive crisis, which is an acute and severe rise in blood pressure (BP) presenting with highly heterogeneous profiles ranging from the absence of symptoms to life-threatening acute target organ damage [1,2,3]. A hypertensive emergency is associated with severe and potentially life-threatening acute target organ damage, thereby requiring hospitalization, preferably in an intensive care unit, for prompt BP control by the intravenous administration of antihypertensive drugs. Hypertensive urgency is associated with severe BP elevation without acute or impending target organ damage. These patients are treated by the reinstitution or intensification of oral antihypertensive drugs, Licensee MDPI, Basel, Switzerland.

Objectives

Methods

Results

Conclusion