Clinical study of hypertensive crisis at a tertiary care hospital of South India

Authors

  • M. Sai Varun Department of Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Usham Gangaram Department of Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • M. V. Nagabushana Department of Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • H. G. Revana Siddappa Department of Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Bhimasen Soren Department of Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20183831

Keywords:

Arterial hypertension, Hypertensive urgency, Hypertensive emergency

Abstract

Background: Hypertensive crisis is a severe clinical condition in which sudden increase in arterial blood pressure can lead to acute vascular damage of vital organs. So timely detection, evaluation and adequate treatment are crucial to prevent permanent damage to vital organs. The aim of the present study is to evaluate incidence and clinical presentation of hypertensive crisis in relation to age, sex, severity of hypertension, accompanying symptoms and clinical manifestations.

Methods: It is a clinical prospective study done during the period between January to June 2018 at Narayana Medical College, Nellore. All patients who were more than 18 years with blood pressure>180/120 mmHg to the emergency, outpatients, and inpatients were included. A thorough History and clinical examination was done and necessary investigation was sent to the laboratory.

Results: The study results indicate that males (64%) were significantly over represented compared to females (36%). Out of 50 patients majority of the subjects belonged to age group of 50-59 years. Out of 50 Patients most common symptom is Headache (48%), Vomiting (48%), Giddiness (38%), Dyspnoea (22%), Loss of consciousness (22%) followed by chest pain (20%), Blurring of vision (20%) and weakness of limbs (14%). Most of the individuals are in the hypertensive emergency (66%) followed by Hypertensive urgency (34%). Out of 50 patients 56% had neurological involvement and 44% had cardiological involvement. Our study states that most of cases were in grade 1retinopathy (8%) followed in order by grade 4 retinopathy (8%), grade 2 retinopathy (6%) and grade 3 retinopathy (6%).

Conclusions: The present study concludes that majority of patients present presenting in hypertensive emergency belonged to fifth and sixth decades of age. So, treating physician should rapidly assess the differentiation of hypertensive emergency and hypertensive urgency in order to prevent end organ damage and to prevent further morbidity and mortality.

References

Hypertensive emergencies Epidemiology - Epocrates Online. [Online]. Available at: //online.epocrates.com/diseases/2723/Hyperten sive-emergencies/Epidemiology. [Accessed: 19-May-2017].

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560-71.

Karras DJ, Ufberg JW, Harrigan RA, Wald DA, Botros MS, McNamara RM. Lack of relationship between hypertension-associated symptoms and blood pressure in hypertensive ED patients. The Ame J Emerge Med. 2005 Mar 1;23(2):106-10.

Zamapaglione. Hypertensive urgencies and emergencies. Hypertension.1996;27:144-7.

Ventura HO, Mehra MR, Messerli FH. Desperate diseases, desperate measures: tackling malignant hypertension in the 1950s. Ame Heart J. 2001 Aug 1;142(2):197-203.

Elliot WJ. Hypertensive emergencies. In Critical Care Clinics, W.B. Saunders company; April 2001;17(2).

Ault MJ, Ellrodt AG. Pathophysiological events leading to the end-organ effects of acute hypertension. Am J Emerg Med. 1985;3(suppl 6):10-5.

Salkic S, Batic-Mujanovic O, Ljuca F, Brkic S. Clinical Presentation of Hypertensive Crises in Emergency Medical Services. Materia Socio-Medica. 2014;26:12-6.

Pacheco HG, Victorino NM, Urquiza JP, Castillo AA, Herrera UJ, Mendoza AA, et al. Patients with hypertensive crises who are admitted to a coronary care unit: clinical characteristics and outcomes. The J Clin Hypertens. 2013 Mar;15(3):210-4.

Martin JF, Higashiama E, Garcia E, Luizon MR, Cipullo JP. Hypertensive crisis profile. Prevalence and clinical presentation. Arq Bras Cardiol. 2004;83(2):131-6. (PubMed).

Singh J, Tewari MK, Khosla PK, Azad R. Hypertensive retinopathy. Indian J Ophthalmol. 1983;31:971-4.

Downloads

Published

2018-09-22

Issue

Section

Original Research Articles