Hypertensive crisis: Insights into prevalence and associated factors at a tertiary care facility in Zambia

Abstract

Background: Hypertensive crisis, including hypertensive emergency (with target organ damage) and hypertensive urgency (without target organ damage), is a critical public health condition at Livingstone University Teaching Hospital (LUTH). Hypertensive crisis has been linked to severe complications, including stroke, renal failure, and heart disease, leading to increased mortality, morbidity, and healthcare costs due to intensive treatment, prolonged hospital stays, and long-term care. This study aimed to determine the prevalence and factors associated with hypertensive crisis among patients presenting at the adult medical emergency department at LUTH.

Method: This was a retrospective cross-sectional study conducted among 977 individuals aged ≥ 18 years who visited the facility between 1st January and 31st December 2021. Hypertensive crisis was defined as systolic BP ≥ 180 mmHg and diastolic BP ≥ 120 mmHg, with or without target organ damage by the attending clinician. Multivariable logistic regression was used to evaluate factors associated with hypertensive crisis. Statistical significance was set at p < 0.05.

Results: The prevalence of hypertensive crisis was 18.9% (95% CI: 17%, 21%) [(n = 185/977)], with 1.1% (n = 11) diagnosed with hypertensive emergency and 17.8% (n = 174) with hypertensive urgency. The most affected group was under 45 years old (n = 89, 48.1%), and Males [50.8%, (n = 94)] and females [49.2%, (n = 92)] were equally affected. Individuals who did not adhere to their hypertension medication were 6.3 times more likely to experience a hypertensive crisis compared to those who adhered (AOR: 6.3; 95% CI: 2.78-13.01; p < 0.001). Individuals in employment were 3.94 times more likely to experience a hypertensive crisis compared to those who were unemployed (AOR: 3.94; 95% CI: 1.52-10.21; p = 0.005). Similarly, individuals diagnosed with a hypertensive crisis had 3.43 times higher odds of being hospitalized than those who were not diagnosed (AOR: 3.43; 95% CI: 1.61-7.34; p < 0.001).

Conclusion: Hypertensive crisis represents a significant burden on our emergency department, which may lead to severe complications such as stroke, renal failure, and cardiovascular events. These complications, in turn, result in increased healthcare costs and patient morbidity in resource-limited settings like ours. Therefore, there is a need to enhance public awareness about hypertension and adopt a patient-centered approach to medication adherence.

Fig 1. Flowchart of eligible files.