Key result
ED hypertensive crisis carries ~2% 24-hour mortality and is linked to pre-existing hypertension.
Why the study?
Hypertensive crisis causes morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa, but its burden, risk factors, and management strategies in district and regional emergency departments were not well determined.
Observational (n=169)
Yes
Hypertensive crisis is common in Tanzanian district and regional hospitals (6.3% of ED patients), but management is often suboptimal with low utilization of intravenous antihypertensives for hypertensive emergencies.
Answers are grounded in this paper and cite their sources.
Supports ED vigilance for pre-existing hypertension; leaves optimal management strategies open for prospective trials.
BACKGROUND: Hypertensive crisis is among the causes of morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa. We aimed to determine the burden, risk factors and describe the management strategies of hypertensive crisis among adult patients seen at emergency departments of district and regional hospitals in Tanzania. METHODS: This was a prospective multicenter longitudinal study which included all 162 district and regional hospitals in Tanzania. It was part of the Tanzania Emergency Care Capacity Survey (TECCS), a large assessment of burden of acute illness and emergency care capacity in Tanzania. Adult patients who presented to emergency departments with blood pressure ≥ 180/110mmHg were enrolled. Demographics, clinical presentation, management, and 24-hours outcomes were recorded using a structured case report form. Descriptive statistics were summarized in frequency and median, while logistic regression was used to evaluate the association between risk factors and presence of hypertensive crisis. RESULTS: We screened 2700 patients and enrolled 169 adults, henceforth proportion of adult patients with hypertensive crisis was 63 per 1000. Median age was 62 years (IQR 50-70 years) and predominantly females, 112 (66.3%). Majority 151(89.3%) were self-referred with two-wheel motorcycle being the commonest 46 (27.2%) mode of arrival to the hospital. Hypertensive emergency was found in over half 96 (56.8%) of the patients with hypertensive crisis, with oral medications administered in more than half of them, 71 (74%) as means to control the high blood pressure, and one-third 33 (34.4%) were discharged home. On multivariate analysis increasing age (AOR 4.53, p < 0.001), use of illicit drug (AOR 4.14, p-0.04) and pre-existing hypertension (AOR 8.1, p < 0.001) were independent risk factors for hypertensive crisis occurrence. CONCLUSION: Hypertensive crisis among adult patients attending district and regional hospitals is common (63 patients per every 1000 patients). Increasing age, use of illicit drug and pre-existing hypertension are independent associated factors for developing hypertensive crisis.
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Kilindimo et al. (2023) conducted an observational in Hypertensive crisis (n=169). Hypertensive crisis occurred in 63 per 1000 adult patients presenting to emergency departments, with a 24-hour mortality of 1.8%, and pre-existing hypertension identified as a major independent risk factor.
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