Risk of cardiovascular events after a first admission to the emergency department for an hypertensive emergency or urgency: a two years follow up

Background: At present, few data are available on the prognosistic significance of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events (CV) during follow-up in hypertensive patients admitted to an ED of the Brescia Hospital (Northern Italy) with hypertensive emergencies (HE) or urgencies (HU). Methods: Between January and December 2008, medical records of patients aged >18 yrs, admitted to the ED of the Spedali Civili di Brescia with blood pressure values ≥180 mmHg (SBP) and/or ≥120 mmHg (DBP) were collected and analysed (328 pts were classified as "hypertensive emergency", 890 pts as "hypertensive urgency", 380 pts as "pseudo hypertensive urgency" and 38 pts with "hypertensive urgency and a first diagnosis of hypertension"). Data on 947 patients were analysed; the mean duration of follow-up after admission to the ED was 2 years. Results: A first fatal or non fatal CV event occurred in 226 patients (62 cardiovascular events, 45 cerebrovascular events, 42 hospital admissions for heart failure, 46 cases of new onset kidney failure and 31 cases of new-onset diabetes). Patients with CV events were older, more frequently males, with a higher prevalence of diabetes mellitus and previous CV disease, and a greater proportion of inadequate BP control. During the follow-up a new episode of "hypertensive crisis" was recorded in 203 pts (24%). The incidence of hypertensive crises was significantly higher in patients with hypertensive emergency in comparison with hypertensive urgency (p=0.03). The incidence of fatal and non fatal events was 14.8, 5.1, 5.3, 2.5 per 100 patient-years in patients with hypertensive emergency, urgency, pseudo-urgency and first diagnosis of hypertension, respectively (p<0.001 emergency vs others, by the log-rank test). Similar results were obtained when we considered separately the occurrence of cardiovascular, cerebrovascular or renal events. Conclusions: Admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for a strict and accurate follow-up in patients with hypertensive crises.