HYPERTENSIVE EMERGENCIES IN A TERTIARY CARE CENTRE
-DR.SUBHASHINI.K
INTRODUCTION
Systemic Hypertension is one of the most
common comorbid conditions worldwide. It
can cause multiple organ damages.
Hypertensive emergency is define as increase
in blood pressure to > 180 mmHg systolic and
> 110 mmHg diastolic with target organ
damage.
AIM
To evaluate the various modes of presentation
and factors contributing to hyertensive
emergencies.
MATERIALS AND METHODS
This study was hospital based prospective study.
It was carried out in 100 patients admitted in
emergency department in Govt.Kilpauk medical
college hospital over a period of three months.
Patients fulfilling the eligible criteria were
included.
Inclusion Criteria
• Patients above 18 years of age
• Systolic blood pressure of 180mm Hg or above
or diastolic blood pressure of 110 mm Hg or
above .
Study data was collected from 100 patients
admitted to this hospital over a period of three
months. Patient who presented with a Systolic
blood pressure of ≥180 or diastolic blood pressure
of ≥110 mmHg, with history suggestive of acute
target organ damage were included in the study. A
detailed history was taken particularly regarding
comorbid illnesses, drug compliance and reasons
for non compliance.
The routine investigations done in these patients
were complete blood count, blood sugar, serum
urea, serum creatinine serum electrolytes, fasting
lipid profile,chest xray, electrocardiogram and
urine analysis. Computed tomography of the
brain was done in certain patients. Patients with
cardiovascular dysfunction clinically were
evaluated with echocardiography and patient with
renal dysfunction underwent renal sonography.
The collected data was analyzed using Microsoft
Excel software
GOVT.KILPAUK MEDICAL COLLEGE HOSPITAL.CHENNAI
RESULTS: • Out of 100 patients 61 patients (52%)
had ST segment of T wave abnormalities,
Of the 100 patients data obtained there were 72 male and 28 26 (20%) had ECG with voltage criteria
female. Age Male Female suggestive of LVH and 13 patients had
Age wise distribution both the changes.
18-40 9 2 • Echocardiography done in 71 patients
40-60 52 12 with evidence of cardiac dysfunction
60-80 11 14 showed regional wall motion
abnormality in 4 patients ), global
Five presentations seen were : hypokinesia of lv in 30 patients
(39.47%), left ventricular hypertrophy in
33 patients (18.4%) and normal study in
4 patients (7.8%)
ACUTE CEREBROVASCULAR AC-
CIDENT
ACUTE PULMONARY EDEMA
EPISTAXIS
ACUTE CORONARY SYNDROME
HYPERTENSIVE ENCEPHALOPATHY
CONCLUSION:
Hypertensive emergency is a cause of
morbidity and mortality worldwide and hence
the varied presentations and treatment
followed needs to be analysed[1].
• Of the acute cva – 84 % was hemorrhagic and 16% was
In patients with known hypertensive
ischemic infarct.
disorders on medication non compliance
• Of the Acute coronary syndromes- STEMI (62.5%) and
being the most important cause of
NSTEMI (37.5%).
uncontrolled hypertension needs to be
• Of the pulmonary edema patients 65% had chronic
analysed[2][3].
kidney disease , 21% had CAD and 43 % had both
Proper education about the hazards of
coronary artery disease and CKD
hypertension among public might bring down
• The common comorbid conditions associated were CAD,
the rates of non compliance and hence reduce
CKD, Diabetes mellitus and Dyslipidemia.
this catastrophic event.
• The common presenting symptoms were
5
HEMIPLEGIA GIDDINESS
23% 23%
REFERENCES:
1. Zampaglione, Bruno, et al.
ALTERED “Hypertensive Urgencies and
HEMISENSORY
LOSS 7.6 % SENSORIUM Emergencies.” Hypertension, vol. 27,
7.6 %
no. 1, Jan. 1996, pp. 144–
47. ahajournals.org (Atypon),
https://doi.org/10.1161/01.HYP.27.1.144
SEIZURES
3.4 %
DYSPNEA 63 % 2. Saguner AM, Dür S, Perrig M,
Schiemann U, Stuck AE, Bürgi U, Erne
P, Schoenenberger AW. Risk factors
promoting hypertensive crises: evidence
CHEST PAIN 8% HEADACHE from a longitudinal study. Am J
9%
Hypertens. 2010 Jul;23(7):775-80.
3.Alley, William D., and Eddie L. Copelin II.
“Hypertensive Urgency.” StatPearls,
• Cause of the condition was probed and showed newly
StatPearls Publishing, 2022. PubMed,
diagnosed systemic hypertension (44%), non compliance
http://www.ncbi.nlm.nih.gov/books/NBK513
of drugs (52%) and reason unknown (14%).
351/
• Non compliance showed irregular followup(75%) , lost to
followup(21%) and over the counter(4%) management of
hypertension.
• 7% received single drug therapy , 48% double drug and
11% triple antihypertensive therapy.
• Most commonly used drug was Calcium channel
blockers(66%).
• Chest radiograph was suggestive of cardiomegaly in 18
patients.