Clinical presentation, management and treatment outcomes of patients with hypertensive urgency and emergency presenting to the emergency department of Muhimbili national hospital, Dar es salaam, Tanzania

Abstract

Background: Hypertensive crises are clinical syndromes grouped as hypertensive urgency and emergency, which occur as complications of untreated or inadequately treated hypertension. Emergency Departments (ED) cross the world are the first points of contact for patients with hypertensive crises. In Tanzania, there is general paucity of data on patients with hypertensive crisis presenting to ED and other acute intake areas. Objective: To describe the profile and outcome of patients with hypertensive urgency and emergency presenting to the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Methodology: A descriptive cohort study of consecutive convenient patients presenting to the EMD-MNH over a four-month period. Structure data sheet was completed, documenting demographic information, clinical presentation, diagnostic evaluations, EMD treatment, outcome and disposition. Descriptive statistics is described as percentage, mean, median, and confidence intervals with P values of less than 0.05 are used to show the statistically significant differences. Results: We screened 8002 patients and enrolled 203 (2.5%) patients, 53.2% were females; the overall median age was 55 years (IQR 21-96 years). 138 (68%) patients had hypertensive emergency and 65 (32%) patients had hypertensive urgency. The commonest presenting symptom in hypertensive emergency was altered mental status 74 (53.6%) while the commonest physical finding was low GCS 61 (44.2%). None of patients with hypertensive urgency had any of these symptoms or physical findings. Overall Cerebrovascular accident was the most common 63 (31%) final EMD diagnosis. 112 (81.2%) patients with hypertensive emergency were admitted and 3 died in EMD, while 24(36.9%) patients with urgency were admitted and none died at EMD. The overall in-hospital mortality rates for hypertensive emergency and urgency were 26.8% 95% CI(19.42,34.2%)vs.3.1% 95%CI (-1.12, 7.28%) respectively. Conclusion: The prevalence of hypertensive crisis among adult patients presenting to EMD-MNH is around 1.3%, with no significant difference between patients with hypertensive emergency and urgency. Most patients were female, presented with altered mental status, headache, shortness of breath, and CVA was the most common EMD diagnosis. Most patients with hypertensive emergency were admitted, while most patients with urgency were discharged. The overall hospital mortality was nine times higher in patients with hypertensive emergency than those with hypertensive urgency.