HYPERTENSIVE URGENCY, EMERGENCY AND KIDNEY FUNCTION

Abstract

Objective: The aim of this study was to determine risk factors for hypertensive crisis development just as an impact of the kidney function on it. Design and method: From January to October 2019, 237 patients (109 males, 128 females) with hypertensive crisis were analyzed at the Emergency department in Clinical Hospital Merkur, Zagreb. We defined the hypertensive crisis as a rapid increase in blood pressure above 180/120mmHg (SBP range 182–260mmHg). Hypertensive crises were divided into two subgroups due to the evidence of end-organ damage. Elementary lab results and pulse wave velocity were checked in all patients. Results: Hypertensive urgency was found in 184 patients (77.64%), emergency in 53 (22.36%). Comparison of these two subgroups showed that patients with an emergency were significantly older (70.51 vs. 64.44 years, p < 0.01), had significantly elevated serum glucose levels (10.04 vs. 6.94mmol/L, p < 0.0001), decreased glomerular filtration rate (CKD-EPI formula 75.96 vs. 59.15 mL/min/1.73m2, p < 0.0001) and high heart rate (mean 96.32 vs. 77.17bpm, p < 0.0001) which showed as the most significant risk factor. Body mass index didn’t show any relevance in the hypertensive crisis development (31.26 vs. 30.58 kg/m2, p = 0.18). Hypertensive emergency incidence increased with a decline in kidney function. Such events developed in 16.94% patients with CKD stage 1, 14.42% in stage 2, 34.61% in stage 3a, 50.00% in stage 3b, 60.00% in stage 4 and 50.00% in stage 5. Within main groups, patients were divided into two groups whether they used antihypertensive medication. A group of 53 patients was without medication (22.36%) of which 13 met criteria for a hypertensive emergency. Pulse wave velocity was much higher in patients with CKD-EPI < 45 ml/min/1.73m2 (13.01 vs. 10.74m/s, p = 0.01). Even though female patients were significantly older (69.02 vs. 62.02years, p < 0.0001), no other differences between genders were found. Conclusions: Age, elevated plasma glucose and a decline in glomerular filtration rate combined with high heart rate values, but gender and body mass index independently are the main factors which are linked to the development of hypertensive emergency.