Clinical presentation and management of patients with uncontrolled, severe hypertension

Results from a public teaching hospital

Richard A Preston, N. M. Baltodano, J. Cienki, Barry J Materson

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Context: There is relatively little data available on the management of patients with severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications. Objective: To determine the incidence, clinical features, acute management, and clinical course of severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications presenting for emergency department care in a large public teaching hospital. Design: Chart survey of consecutive emergency department visits. Patients: Ninety-one of 2898 consecutive visits to a public teaching hospital emergency department were specifically for severe, uncomplicated hypertension. Results: Of 2898 consecutive medical emergency department visits, there were 142 (4.9%) patient visits specifically for systolic blood pressure (SBP) ≥ 220 mmHg or diastolic blood pressure (DBP) ≥ 120 mmHg. Ninety-one of the 142 patient visits were for severe hypertension in the absence of acute target organ impact or neuroretinopathy received acute drug therapy. Twenty-nine received two drugs, and 15 received three drugs. Sixty-eight patients (75%) received clonidine, and 15 (16.5%) received short-acting nifedipine despite widely published concerns about the safety of this practice. We found a wide variability of blood pressure response to treatment. The average decline in SBP was 50 ± 31 mmHg and the average decline of DBP was 34 ± 20 mmHg over 4.2 ± 2.9 h. Forty-two patients (46%) had the SBP reduced to less than 160 mmHg, and 46 patients (50%) the DBP to less than 100 mmHg. Long-term management and follow-up were suboptimal. Of 74 patients discharged from the emergency room, 22 patients (30%) returned because of uncontrolled hypertension within an average of 33 ± 28 days, 10 patients with hypertensive complications. Conclusions: Severe hypertension continues to present an important and common problem. Physicians appear to place a strong emphasis on acute lowering of the blood pressure to near-normal levels. Patients are frequently lost to follow-up and have a very high rate of recurrent emergency department visits and hypertensive complications. This study points to a need for detailed, specific practice guidelines and comprehensive disease management protocols for severe, uncomplicated hypertension.

Original languageEnglish
Pages (from-to)249-255
Number of pages7
JournalJournal of Human Hypertension
Volume13
Issue number4
StatePublished - Apr 29 1999

Fingerprint

Public Hospitals
Teaching Hospitals
Blood Pressure
Hypertension
Hospital Emergency Service
Lost to Follow-Up
Hospital Departments
Clonidine
Emergency Medical Services
Nifedipine
Disease Management
Practice Guidelines
Pharmaceutical Preparations

Keywords

  • Hypertension
  • Hypertensive crisis
  • Hypertensive emergency
  • Hypertensive urgency
  • Severe hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Clinical presentation and management of patients with uncontrolled, severe hypertension : Results from a public teaching hospital. / Preston, Richard A; Baltodano, N. M.; Cienki, J.; Materson, Barry J.

In: Journal of Human Hypertension, Vol. 13, No. 4, 29.04.1999, p. 249-255.

Research output: Contribution to journalArticle

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abstract = "Context: There is relatively little data available on the management of patients with severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications. Objective: To determine the incidence, clinical features, acute management, and clinical course of severe, uncomplicated hypertension and severe hypertension with stable hypertensive complications presenting for emergency department care in a large public teaching hospital. Design: Chart survey of consecutive emergency department visits. Patients: Ninety-one of 2898 consecutive visits to a public teaching hospital emergency department were specifically for severe, uncomplicated hypertension. Results: Of 2898 consecutive medical emergency department visits, there were 142 (4.9{\%}) patient visits specifically for systolic blood pressure (SBP) ≥ 220 mmHg or diastolic blood pressure (DBP) ≥ 120 mmHg. Ninety-one of the 142 patient visits were for severe hypertension in the absence of acute target organ impact or neuroretinopathy received acute drug therapy. Twenty-nine received two drugs, and 15 received three drugs. Sixty-eight patients (75{\%}) received clonidine, and 15 (16.5{\%}) received short-acting nifedipine despite widely published concerns about the safety of this practice. We found a wide variability of blood pressure response to treatment. The average decline in SBP was 50 ± 31 mmHg and the average decline of DBP was 34 ± 20 mmHg over 4.2 ± 2.9 h. Forty-two patients (46{\%}) had the SBP reduced to less than 160 mmHg, and 46 patients (50{\%}) the DBP to less than 100 mmHg. Long-term management and follow-up were suboptimal. Of 74 patients discharged from the emergency room, 22 patients (30{\%}) returned because of uncontrolled hypertension within an average of 33 ± 28 days, 10 patients with hypertensive complications. Conclusions: Severe hypertension continues to present an important and common problem. Physicians appear to place a strong emphasis on acute lowering of the blood pressure to near-normal levels. Patients are frequently lost to follow-up and have a very high rate of recurrent emergency department visits and hypertensive complications. This study points to a need for detailed, specific practice guidelines and comprehensive disease management protocols for severe, uncomplicated hypertension.",
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