Background: Hypertensive emergencies are still a common mode of finding hypertension. Objective: to determine the epidemiological, clinical and paraclinical characteristics of the hypertensive emergency, and to evaluate the factors associated with poor blood pressure control. Patients and method: cross-sectional and analytical study, conducted from July 2010 to June 2014 (4 years), in the cardiology department of the Brazzaville University Hospital. Included, patients admitted were those systolic blood pressure (BP) ≥ 180 mm Hg, and diastolic BP ≥ 110 mm Hg, with target organ involvement. A minimum biological assessment, an ECG, a chest X-ray, a brain CT-scan and a cardiac ultrasound were required. Results: Fifty patients were included, including 31 women (62%). The mean age was 53.8 ± 13.7 years old, age < 60 years (n = 34 ; 68%), low income population (n = 23 ; 46%). Hypertension was often known (n = 49; 98%), and poor compliance (n = 33; 67.4%). Associated risk factors were: obesity (n = 13), and diabetes (n = 7). The average consultation time was 4.1 ± 3.7 days. The reasons for hospitalization were: dyspnea (n = 24 ; 48%), neuro-sensory signs (n = 24 ; 48%), and functional limb impotence (n = 15 ; 30%). The major laboratory abnormalities were hyperuricemia (n = 16 ; 32%) and hyperglycemia (n = 16). Left ventricular hypertrophy was noted at the ECG (n = 29 ; 58%). Cardiac ultrasound showed a LVEF < 40% (n = 8). The main hypertensive emergencies were: heart failure (n = 23 ; 46%), stroke (n = 23 ; 46%), severe renal failure (n = 10 ; 20%), and malignant hypertension (n = 23; 4 6 %). The average hospital stay was 11.4 ± 5.5 days, and 1 death was recorded. BP was uncontrolled in 38 cases (76%). Factors associated with uncontrolled blood pressure were: female sex (OR 3 ; 95% CI 0.8 - 11.5) and low-income patient (OR 1.26 ; 95% CI 0.34 - 4.68). Conclusion: organs affected during hypertensive emergencies are most often the heart, the brain and the kidney in our context. Early management of hypertension w ill reduce these complications.
Hypertension (HT) is a global public health problem, with its prevalence estimated at 34.9%, and its impact on mortality of more than 10.5 million per year [
Hypertensive emergencies are a common mode of HT discovery in blacks. Indeed, Maweni reported that 46% of hypertensive emergencies revealed hypertension in black patients [
The purpose of this study was to determine the epidemiological, clinical and paraclinical characteristics of hypertensive urgency, and to evaluate the factors associated with poor blood pressure control.
Type of study, period, setting: This was a cross-sectional study, conducted from July 2010 to June 2014 (4 years) in the cardiology and internal medicine department of the Brazzaville University Hospital. Inclusion: Patients admitted for hypertension with systolic 180 mm Hg and/or diastolic 110 mm Hg and target organ involvement, were selected. Chosen files had the WHO minimum assessment of HT, an electrocardiogram (EKG), a chest X-ray, a cardiac ultrasound and the brain CT-scan or fundus examination depending on the case. Patients with incomplete records were excluded. Anonymity was required according to the Helsinki Protocol of 1975.
Items: The analyzed parameters were epidemiological, clinical, paraclinical, therapeutic and prognostic.
Definitions:
- Consultation delay: average time between onset of symptoms and date of hospitalization.
- Patient with low income: based on the average income below the minimum required by the country and the profession according to the family survey carried out by the ministry of plan (republic of the Congo) [
- Poor treatment compliance: hypertensive patient who has abandoned the treatment and does not respect the hygiene measures.
- Obesity: body mass index ≥ 30.
- Diabetes: patient treated for diabetes or having a fasting blood sugar ≥ 1.26 g/L away from the admission.
- Hyperuricemia: uricemia 60 mg/L in women and 70 mg/L in men [
- Hypokalemia: serum potassium < 3.5 mEq/L.
- Anemia: hemoglobin rate less than 2 units compared to usual values, or <11 g/dL in women and <12 g/dL in men.
- Severe renal failure: glomerular filtration rate (GFR) calculated according to the Crocroft and Gault formula < 30 ml/min.
- Cardiomegaly on chest X-ray: cardio-thoracic index greater than 0.55.
- Left ventricular hypertrophy (LVH) on EKG: Sokolow-Lyon index > 35 mm, or Cornell index [
- Left ventricular ejection fraction (LVEF) lowered: ejection fraction < 30% calculated according to the Simpson method with a ToshibaÒ ultrasound system.
- Alteration of glomerular filtration rate: glomerular filtration rate calculated by the Crockroft and Gault formula < 30 ml/min.
- No control of blood pressure: systolic 140 mm Hg and/or diastolic 90 mm Hg.
Statistical analysis: the data was entered into Microsoft Excel and processed by Epi Info (CDC Atlanta, USA). The qualitative variables were represented in terms of numbers (n) and percentage (%). Quantitative variables were represented in mean standard deviation and extremes. The comparison of the averages used Student’s t-tests. A calculation of Odds Ratio (OR) and 95% confidence interval (CI) was performed to determine associated factors. The threshold of significance for comparisons was <5%.
Fifty patients were included, 31 women (62%). The frequency of hypertensive emergencies was 7% in cardiology. The mean age was 53.8 ± 13.7 years (range: 30 to 90 years). Age was <60 years in 34 cases (68%). The low income patient was found in 23 cases (46%). Patients were referred in 9 cases (18%). The average consultation delay was 4.1 ± 3.7 days (range: 1 and 15 days). This delay was 4.2 ± 3.7 days for men vs. 4.1 ± 3.8 days for women (p > 0.05). HT was often known (n = 49; 98%), and patients were poor observers (n = 33; 67.4%). Known cardiovascular risk factors were: obesity (n = 13; 26%), diabetes (n = 7; 14%), dyslipidemia (n = 7; 14%), family history of early cardiovascular disease (n = 7; 14%), excessive alcohol consumption (n = 1).
The reasons for hospitalization were represented by: exercise dyspnea (n = 24; 48%) including orthopnea (n = 17), neuro-sensory signs (n = 24, 48%), functional impotence limb (n = 15; 30%), disturbances of consciousness (n = 5), dysarthria (n = 1), epistaxis (n = 1).
The examination has shown an average systolic BP of 221.2 ± 26.2 mm Hg (range: 181 to 282), and a diastolic BP of 129.8 ± 21 mm Hg (range 111 to 152). Congestive HF was found (n = 23; 46%) including acute pulmonary edema (n = 18). Hemiplegia was reported (n = 24; 48%).
Biological, EKG, radiological, and echocardiographic parameters are reported in
Blood pressure was normalized at discharge in 12 cases (24%). Factors associated with non-control of blood pressure (n = 38; 76%) at discharge are reported in
Mean ± e.t or n (%) | |
---|---|
Serum analysis | |
Creatinin (mg/L) | 18.7 ± 15.1 |
Hemoglobin (g/dL) | 12.9 ± 2 |
Hematocrit (%) | 42.6 ± 5.9 |
Kaliemia (mEq/L) | 4 ± 0.6 |
Uricemia (mg/L) | 63.4 ± 24.3 |
Glycemia (g/L) | 1.4 ± 0.7 |
EKG | |
LVH | 29 (58) |
Repolarization desorders | 13 (26) |
Complete cardiac block | 2 (4) |
Cardiac ultrasonography | |
LVEF (%) | 66.4 ± 9.6 |
Concentric LVH | 12 (24) |
LVEF < 30% | 8 (16) |
n (%) | Odds ratio | 95% CI | p-value | |
---|---|---|---|---|
Male sex | 12 (31.5) | 0.33 | 0.09 - 1.26 | 0.103 |
Female sex | 26 (68.5) | 3.03 | 0.8 - 11.5 | 0.103 |
Patient with low income | 18 (47.3) | 1.26 | 0.34 - 4.68 | 0.73 |
Obesity | 6 (15.8) | 0.13 | 0.03 - 0.55 | <0.01 |
Hyperuricemia | 12 (31.5) | 0.32 | 0.08 - 1.25 | 0.103 |
Heart failure | 15 (39.5) | 0.33 | 0.08 - 1.29 | 0.107 |
Stroke | 20 (52.6) | 0.79 | 0.21 - 2.94 | 0.73 |
Severe renal failure | 6 (15.8) | 0.38 | 0.09 - 1.68 | 0.19 |
The limits of the study: The study was a documentary review. Records of all patients with hypertensive urgency were retained. The size of sample is reduced because rejected files without blood chemistry and morphological examinations by the authors. Nevertheless, this is a preliminary study and the compilation of the files will continue.
Hypertensive emergencies represent clinical situations requiring treatment in an intensive care unit [
In our series, female sex predominated, but Maweni reported a similar prevalence in both sexes [
The associated biological abnormality that prevailed was hyperuricemia. It is a common cardiovascular risk factor and is an independent factor in stroke mortality [
The most common clinical features were HF and stroke. This situation was described in Brazzaville in emergencies [
Mortality at one year remains high, 26.8% for Shao and 79% for Aronow [
Organs damaged during hypertensive emergencies are most often the heart, brain and kidney in our context. The control of the blood pressure remains difficult. Primary prevention and early management of hypertension will limit these complications.
The authors declare no conflicts of interest regarding the publication of this paper.
Ngamami, S.F.M., Mbolla, B.F.E., Ebinda, G.B., Landa, C.M.K., Kafata, L.I.O., Ikama, M.S., Gombet, T.R. and Kaky, S.-G.K. (2019) Hypertensive Emergencies in the Department of Cardiology at the Teaching University Hospital of Brazzaville (Republic of the Congo): Preliminary Study. World Journal of Cardiovascular Diseases, 9, 1-8. https://doi.org/10.4236/wjcd.2019.91001