HYPERTENSIVE URGENCIES AND EMERGENCIES - PREVALENCE AND CLINICAL PRESENTATION

The prevalence and clinical picture of hypertensive urgencies and emer gencies in an emergency department are poorly known. The aim of the pr esent study was to evaluate the prevalence of hypertensive crises (urg encies and emergencies) in an emergency department during 12 months of observation and the frequency of end-organ damage with related clinic al pictures during the first 24 hours after presentation. Hypertensive crises (76% urgencies, 24% emergencies) represented more than one fou rth of ail medical urgencies-emergencies. The most frequent signs of p resentation were headache (22%), epistaxis (17%), faintness, and psych omotor agitation (10%) in hypertensive urgencies and chest pain (27%), dyspnea (22%), and neurological deficit (21%) in hypertensive emergen cies. Types of end-organ damage associated with hypertensive emergenci es included cerebral infarction (24%), acute pulmonary edema (23%). an d hypertensive encephalopathy (16%) as well as cerebral hemorrhage, wh ich accounted for only 4.5%. Age (67+/-16 versus 60+/-14 years [mean+/ -SD], P<.001) and diastolic blood pressure (130+/-15 versus 126+/-10 m m Hg, P<.002) were higher in hypertensive emergencies than urgencies. Hypertension that was unknown at presentation was present in 8% of hyp ertensive emergencies and 28% of hypertensive urgencies. In conclusion hypertensive urgencies and emergencies are common events in the emerg ency department and differ in their clinical patterns of presentation. Cerebral infarction and acute pulmonary edema are the most frequent t ypes of end-organ damage in hypertensive emergencies.