Management of Hypertensive Crisis in the Emergency Department, An Italian Epidemiological Study. Preliminary Data

Introduction: Aim of our experimental epidemiological study was to improve the understanding of the clinical condition of acute, severe hypertension managed in the Emergency Department (ED). We evaluated epidemiological data of the in-hospital mortality, end-organ damage, time to achieve controlled blood pressure. We show preliminary data collected in the period October-December 2009. Patients and Methods: 48 patients were studied until now (28F,20 M,mean age 68.6yrs) arriving in ED with elevated blood pressure (BP). We recorded anamnestic data, physical examination, blood tests, levels of BP leading to initiation of treatment, antihypertensive medications used, time required to achieve blood pressure control, in-hospital outcomes. Results: mean Sistolic BP/Diastolic BP(SBP/DBP) at admission was 212.3/105.8 mmHg(mean BP 141.3mmHg), and at pressure control (after mean 5.5 hours) was 143.7/76.5 mmHg(mean BP 98.9mmHg). Medications used for BP control were in 93.7% of cases intravenous drugs (iv), and in a short percentage of cases oral drugs (6.3%). Patients presented history of hypertension 70.8%, diabetes 20.8%, cardiac ischemic disease 25%, chronic cerebro-vascular disease 6.2%, chronic kidney failure 2%. The in-hospital outcomes consist mainly in hospitalization (66.7%) for complications, or for those cases of poor pressure control after more than 24 hours of stay in ED (8 patients). No patients died in ED. 29/48 patients completed a 30-days follow-up, and no events have been recorded until now. Conclusions: Preliminary data, show that hypertensive crisis is 1% of the total visits in our ED in a period of 3 months. In ED it is treated mainly with iv drugs, but also oral drugs are used. This indicates that ED physician's decision making for hypertension therapy is not standardized yet. The time required in pressure control is 5.5 hours, and this mirrors the different behaviours of ED physicians based on individual skill and experience. We are continuing the study to achieve a larger number of data useful to build a sort of “standardized protocol” for the diagnosis and treatment of hypertensive crisis in ED.