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Hypertensive emergencies and urgencies

a single-centre experience in Northern Italy 2008–2015

Salvetti, Massimo; Paini, Anna; Colonetti, Efrem; Tarozzi, Luca; Bertacchini, Fabio; Aggiusti, Carlo; Stassaldi, Deborah; Rosei, Claudia Agabiti; Rosei, Enrico Agabiti; Muiesan, Maria Lorenza

doi: 10.1097/HJH.0000000000002213
Original Article: PDF Only
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Background: An increasing attention is given to emergency departments (EDs) admissions for an acute and severe rise in blood pressure (BP). Data on epidemiology and treatment of hypertensive emergencies and urgencies admitted to ED are still limited. The aim of our study was to evaluate the prevalence, clinical presentation and treatment of patients admitted for hypertensive emergencies or hypertensive urgencies.

Methods: Medical records of consecutive patients aged at least 18 years, admitted to the ED of the Spedali Civili in Brescia in 2008 and in 2015 and presenting with SBP at least 180 mmHg and/or DBP at least 120 mmHg were prospectively collected and analysed.

Results: The prevalence of patients admitted with acute BP rise was 2.0% (n = 1551, age 70 ± 14 years) in 2008 and 1.75% (n = 1214, age 69.7 ± 15 years) in 2015. According to the clinical presentation and the presence of acute organ damage, patients were defined hypertensive emergencies (20.4 and 15.4%, respectively, in 2008 and 2015) or as hypertensive urgencies (79.6 and 84.5%, respectively, in 2008 and 2015). SBP and DBP values were higher in patients with emergencies than in those with urgencies (BP 193 ± 15/102 ± 15 vs. 189 ± 13/96 ± 13 mmHg in 2008 and 192 ± 17/98 ± 15 vs. 189 ± 12/94 ± 15 mmHg in 2015, P < 0.001 for both).

Among hypertensive emergencies, the different forms of organ damage were 25% acute coronary syndromes and 1% aortic dissection in both periods, 34 and 38% acute heart failure, 40 and 37% stroke.

Conclusion: Admission to the ED for hypertensive emergencies and hypertensive urgencies is still high. Diagnosis and treatment are still not appropriate and require the rapid application of recently published guidelines.

Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia - 2a Medicina–ASST Spedali Civili Brescia, Brescia, Italy

Correspondence to Maria Lorenza Muiesan, Department of Clinical & Experimental Sciences, University of Brescia, Department of Internal Medicine, ASST Spedali Civili di Brescia, Piazzale Spedali Civili n 1, Brescia 25123, Italy. Tel: +39 030 3998721; fax: +39 030 3388147; e-mail: marialorenza.muiesan@unibs.it

Received 23 May, 2019

Revised 3 July, 2019

Accepted 15 July, 2019

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