Clinical study of hypertensive emergencies in young patients in tertiary health care centre

Abstract

Background: The incidence and prevalence of hypertensive emergency have been little addressed in the literature. However, over the last decade increasing numbers of young patients with different forms of hypertensive crisis have been observed in emergency departments. We performed this study to ascertain the clinical and epidemiological characteristics of patients aged ≤ 40 years admitted with a diagnosis of hypertensive emergency. Hypertension is one of the leading causes of the global burden of disease. Approximately 7.6 million deaths and 92 million disability-adjusted life years worldwide were attributed to high blood pressure in 2010.Hypertension doubles the risk of cardiovascular disease, including coronary heart disease, congestive heart failure, ischemia and hemorrhagic stroke, renal failure, and peripheral arterial disease. Material & Methods: This Observational study was done on rural patients with hypertensive emergencies admitted to Intensive Cardiac Care Unit, in the Department of General Medicine in Government tertiary rural health Care Hospital of JIIU”,Badnapur,Jalna, from January 2014 to June 2015 (50 patients) . On admission, detailed history was taken and complete clinical examination was done. Patients with an elevated systolic blood pressure of ≥ 180mmHg or diastolic blood pressure of ≥ 120mmHg, with history suggestive of acute target organ damage or with laboratory evidence of target organ damage were included in the study. The data obtained was analyzed by descriptive statistics by means of percentage, proportions and depicted via bar charts, pie charts. Results: Males had higher chances of developing a hypertensive emergency as compared to females, 66% of the patients were males. Male to female ratio was 2.57:1.The commonest presenting symptoms were neurological deficit (50%), dyspnoea (30%), followed by chest pain (24%). Majority of the patients were known hypertensives (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, and in hospital mortality of 20% was observed. The incidence of coronary artery disease in men increased in an almost linear mode as age is increased. Hemiparesis accounted for the largest group of patients with neurological deficit. This evidence confirms that hypertensive emergencies were higher in patients with previously known hypertension. This also shows that patients with hypertension are at a higher risk of developing a hypertensive emergency, more so if they do not adhere to the antihypertensive therapy. Diabetes mellitus and dyslipidemia were the other risk factors; Patients with diabetes mellitus and dyslipidemia were 24% and 32% respectively in the present study. The mean reduction in blood pressure in one hour after admission to the hospital was 19 mmHg of systolic blood pressure and 14mmHg of diastolic blood pressure. Blood pressure levels at the time of admission were higher in group of patients expired compared to those who were discharged from the hospital. The higher levels of blood pressure would have added to more severe target organ damage in these patients, with an adverse outcome. This indicates worse prognosis with a higher levels of blood pressure at presentation. The outcome of this study showed an in-hospital mortality of 20% among these patients. Conclusion: Known hypertensives are at a higher risk of presenting with acute target organ damage associated with hypertensive emergency. Commonest mode of presentation was neurological deficit (50%). Acute intracerebral hemorrhage was the commonest target organ damage noted. This indicates worse prognosis with a higher levels of blood pressure at presentation.