Hypertensive emergencies and urgencies: blood pressure management and its relationship with short and medium term outcome

Introduction: Data regarding prevalence and clinical management of hypertensive emergencies and urgencies are lacking and heterogeneous. Aim: To characterize patients with hypertensive emergencies and urgencies admitted to the emergency department (ED) of Niguarda hospital. In this population we also want to evaluate factors associated with organ damage, adherence to guidelines and the impact of blood pressure (BP) management on short-term (admission to hospital and hospital mortality) and medium-term outcomes (recurrence). Methods: We performed a single-center retrospective study collecting data about all adult patients with systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ 120 mmHg admitted to our hospital’s ED during 2017. Results: Admission to ED for BP elevation were 706 (0.95% of total admission to ED), of whom 34.8% were hypertensive emergencies and 65.2% were hypertensive urgencies. Patients with hypertensive emergencies were older, mainly male, with more comorbidities and more symptomatic at ED admission. In the emergencies group, we observe a BP reduction rate of 18.82 ± 12.1% within 110.1 ± 11.9 min; the most used drugs were nitroglycerin, furosemide and labetalol. In the urgencies group, the BP reduction rate was 19% and the most used drug was short-acting nifedipine. Age, sex, smoking, clinical history of heart failure and chronic obstructive pulmonary disease, symptoms at ED admission ad eGFR have been recognized as factors associated with organ damage. Instead, BP at ED admission and its management didn’t appear to have a significant impact on outcomes. Conclusions: Our study demonstrated good adherence to guidelines in the treatment of hypertensive emergency than of hypertensive urgencies. On the other hand, no significant association were found between the BP management in the ED and the short-term and medium-term outcomes.