Critical Care |

Diagnosis and Management of Patients Presenting to the Emergency Department With Hypertensive Crisis FREE TO VIEW

Nirosshan Thiruchelvam, MD; Prasanna Sengodan, MD; Marc Duran, MD; Gaurav Kistangari, MD; Jeevanantham Rajeswaran, PhD; Arash Rashidi, MD
Author and Funding Information

Cleveland Clinic/Fairview, Cleveland, OH

Chest. 2015;148(4_MeetingAbstracts):230A. doi:10.1378/chest.2269868
Text Size: A A A
Published online


SESSION TITLE: Critical Care Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Hypertension (HTN) is a common chronic medical condition affecting over 65 million Americans. The prompt recognition of a hypertensive crisis -hypertensive urgency (HU) or hypertensive emergency (HE) with appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. We analyzed patients admitted from the emergency department (ED) due to hypertensive crisis meeting criteria for appropriate diagnosis and appropriateness of medical management based on Joint National Committee (JNC) guidelines.

METHODS: We conducted a retrospective chart review of patients admitted through ED who were diagnosed with hypertensive crisis at our institution between August 2010 and August 2012.

RESULTS: 200 patients were diagnosed as hypertensive crisis were analyzed. Mean age of the cohort was 61 year ±17 years, and 35% were males. There were 16(8%) patients with hypertensive emergency and 184(92%) with hypertensive urgency. However, among the patients with diagnosis of hypertensive urgency, based on JNC guidelines, 21% patients did not meet the criteria for hypertensive urgency; similarly,13% of patients with a diagnosis of hypertensive emergency did not meet criteria for hypertensive emergency. Although not statistically significant, when compared to patients with HE, a higher number of patients with HU were older (60% vs 31%) and more received beta blockers medications (60% vs 38%). On the other hand, a higher number of patients with HE had previous diagnosis of HTN (100% vs 88%), and had higher rate of documented non adherence to medication (38% vs 27%) when compared to patients with HU. Approximately 33% of patients with HU and 31% of patients with HE were readmitted within 90 days of discharge. 40% of patients with HU and 38% of patients with HE received oral medication within 6 hours (p =0.76) of arrival to the ED. Hypotension (24%), bradycardia (36%), acute renal failure (5.5%) were common complications observed following antihypertensive medications.

CONCLUSIONS: Hypertensive crisis is common clinical problem, with hypertensive urgency being more common than hypertensive emergency. Our data suggests that a good number of patients were misdiagnosed and improperly receiving treatment for hypertensive crisis including triage to ICU admission.

CLINICAL IMPLICATIONS: Distinguishing between hypertensive emergency and urgency and appropriate triaging is crucial to the management of this frequently encountered condition to avoid adverse outcomes.

DISCLOSURE: The following authors have nothing to disclose: Nirosshan Thiruchelvam, Prasanna Sengodan, Marc Duran, Gaurav Kistangari, Jeevanantham Rajeswaran, Arash Rashidi

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543