English

Abstract

BACKGROUND AND OBJECTIVES: The clinical profile of patients with hypertensive emergencies presenting to rural hospitals in a developing country like ours is unknown. The objective of the present study was to evaluate the modes of presentations, clinical profile and spectrum of target organ damage in patients with hypertensive emergencies. METHOD: This observational study was done at SRI ADICHUNCHANGIRI INSTITUTE OF MEDICAL SCIENCES AND REASEARCH CENTER over a period of one and a half years. The study population included patients admitted to this hospital with severely elevated blood pressure with clinical or laboratory evidence of acute target organ damage. The clinical and laboratory profile of 50 patients were evaluated. RESULTS: Males had higher chances of developing a hypertensive emergency compared to females, male: female ratio 2.57:1. The commonest presenting symptoms were neurological deficit (50%), dyspnea (30%), followed by chest pain (24%). Majority of the patients were known hypertensive (70%). Higher levels of blood pressure at presentation were associated with an adverse outcome. Laboratory abnormalities noticed in these patients included hyponatremia and hyperkalemia. Acute intracerebral hemorrhage was the commonest mode of target organ damage. An in hospital mortality of 24% was observed in the present study. INTRODUCTION: Hypertension affects individuals of all classes and across all age groups. The prevalence of hypertension increases with advancing age to the point where more than half of people of 60–69 years of age and approximately three-fourths of those 70 years of age and older are affected.1 The age related rise in SBP is primarily responsible for an increase in both incidence and prevalence of hypertension with increasing age.1 The relationship between blood pressure and risk of cardiovascular disease events is continuous, consistent and independent of other risk factors.1 Hypertension affects approximately one billion individuals worldwide as per the observations made by the Joint national committee on prevention, detection, evaluation and treatment of high blood pressure (JNC VII) report in 2003.1 Higher than optimal blood pressure is the number one attributable risk for death throughout the world and approximately 7.1 million deaths per year are attributed to uncontrolled hypertension.2 Target organ damage resulting from hypertension includes those affecting the brain, heart, kidneys and the eyes. A number of cardiovascular, pulmonary and neurological symptoms are found to be associated with patients in hypertensive emergency with target organ involvement.3 Focal neurological deficits, dyspnea, chest pain, headache, loss of vision, are considered as the commonest symptoms with which patients in hypertension related acute target organ damage present.3 As population ages the prevalence of hypertension will increase even further unless broad and effective preventive measures are implemented.1 DOI: 10.14260/jemds/2014/2693