Hypertensive emergencies and urgencies in an emergency department in Northern Italy

Background: Few data are available on the prevalence of hypertensive emergencies and urgencies and on clinical characteristics of patients admitted to Emergency Departments (ED). Aim of our study was to provide data on the prevalence of hypertensive emergencies and urgencies in an ED in Northern Italy, over a period of 12 months. 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. Results: Out of 77.154 patients admitted to the ED, BP was found ≥180 mmHg (SAP) and/or ≥120 mmHg (DAP) in 2.2%. Medical records were obtained and analysed in 95% of these patients (1636 pts, 44% males, mean age 70±14 yrs, range 18-102). According to the clinical presentation and the presence of acute organ damage 328 pts (20%) were classified as "hypertensive emergency" (HE, BP 193±15/102±15 mmHg) and 1308 pts (80%) as "hypertensive urgency" (HU). Among urgencies we identify 3 subgroups: 890 pts with "hypertensive urgency" (PA 194±15/99±15 mmHg), 380 with "pseudo-hypertensive urgency" (BP 188±11/94±12 mmHg), 38 with "hypertensive urgency and a first diagnosis of hypertension" (BP 193±18/103±14 mmHg). The most frequent symptoms or signs were: chest pain (20%), dyspnoea (18%), neurological changes (17%), headache (11%), arrhythmias (6%), changes in mental status (3%). Among hypertensive emergencies the different forms of organ damage were distributed as follows: 25% acute coronary syndromes, 25% acute pulmonary oedema, 10% atrial and ventricular arrhythmias, 1% aortic dissection, 32% ischemic stroke, 7% hemorrhagic stroke. Patients with HE were more frequently male and patients with "hypertensive urgency and a first diagnosis of hypertension" were younger as compared with all other groups. Conclusions: Admission to the ED for hypertensive emergencies and urgencies is still high. Our results underline the need for a correct diagnosis and classification of these clinical conditions.