HYPERTENSIVE EMERGENCIES AND URGENCIES IN EMERGENCY DEPARTMENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: The prevalence of hypertensive emergencies (HEs) and urgencies (HUs) and of acute hypertension-mediated organ damage (aHMOD) in emergency departments (EDs) is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of HEs and HUs in EDs and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD. Design and method: We conducted a systematic literature search on Pubmed, OVID and Web of Science from their inception to August 22, 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis. Results: Eight studies were analysed, including 1970 HEs and 4983 HUs. The prevalence of HEs and HUs was 0.3% and 0.9%, respectively (O.R.for HUs vs HEs:2.5 (1.4–4.3)). Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorragic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. HU patients were younger than HE patients by 5.4 years and more often complained of non-specific symptoms and/or headache, while specific symptoms were more frequent among HE patients. Conclusions: HEs and HUs are a frequent cause of access to EDs, with HUs being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.