Emergency Care of Acute Hypertension. An Italian Experience

Objective: Scant data are available on the subset of patients who present to emergency departments with acute severe elevations in blood pressure (BP). Recently the STAT registry has highlighted this topic. No recent Italian data are available. We characterized the population afferent to our emergency room (ER) and the medical behavior in treating hypertensive emergency/urgencies. Design: Our study is a retrospective analysis of patients presented to our ER whit acute elevated blood pressure (BP) from January 2008 to Dicember 2008. Methods: Data were collected by querying computerized hospital registry (Gestione Informazioni Pronto Soccorso ed Emergenza – GIPSE). Patients enrolled had BP values over 180/120mmHg for emergencies and upper levels of stage 2 hypertension for urgencies. Patients with known secondary hypertension were excluded. Results: Three hundred eight patients (308) were enrolled for analysis. Mean age was 66 years, 60.4% were women. Five percent had chronic kidney disease, 21.4% had diabetes, 15% had coronary artery disease. Mean BP values were 198.2 mmHg for systolic BP and 104 mmHg for diastolic BP. Therapeutic approach varied enormously both in used drugs and in the way of administration, independently of it was an hypertensive emergency or urgency. The most used drug was furosemide independently of the presence of pulmonary edema. Hypertensive emergencies (with organ damage) were 26.3%; about urgencies, the most common presenting symptom was headache (16.2%). Many patients took at home a multidrug therapy, clearly ineffective; others were untreated (32%) maybe on the persistent belief that elderly need quite high BP levels to keep cerebral perfusion. Conclusions: This study highlights heterogeneity in emergency care of this kind of patients, still lack of information on hypertension and the importance to keep it under control, and the need of guidelines for emergency treatment of acute hypertension.