Hypertensive urgencies and emergencies in the cardiology emergency department: epidemiology, patient profile, and management

Abstract

Hypertensive urgencies (HU) and hypertensive emergencies (HE) are common conditions in the cardiology emergency department (ED), often requiring urgent intervention. Despite their clinical significance, data on patient characteristics, etiologies, and management strategies remain limited. This study aimed to assess the epidemiology, clinical profile, and management of HU and HE in a tertiary cardiology ED. A single-center, observational study was conducted over 12 months, enrolling patients diagnosed with HU/HE (BP ≥ 180/120 mmHg). Demographic data, medical history, symptoms, etiologic factors, and antihypertensive treatments were recorded. Serial blood pressure (BP) measurements were taken to assess BP reduction during the ED stay. Of 4010 cardiology ED visits, 83 patients (2.1%) had HU/HE (median age 65 years, 45.8% male). Most had a history of hypertension (73.5%), with frequent coexisting smoking (56.6%) and dyslipidemia (43.4%). Common symptoms included dyspnea (19.3%) and chest pain (25.3%). Stress (26.8%) and increased salt intake (15.9%) were common etiologic factors. HE was diagnosed in 18 cases (21.7%), and 12.7% of HU cases required hospitalization. Mean BP on admission was 200/100 mmHg, with SBP and DBP reductions of 41 mmHg (-21%) and 18 mmHg (-17%), respectively. Nitrates, anxiolytics, and combination therapies resulted in the greatest BP reductions. In conclusion, HU and HE are frequently observed in hypertensive patients with additional cardiovascular risk factors. Target-organ damage is not solely related to BP levels, emphasizing the need for individualized management strategies.