Clinical Presentation and Management of Hypertensive Crisis at a Tertiary Care Hospital in Saudi Arabia

Background: Hypertension is a major contributor to cerebrovascular, cardiovascular, and renal morbidity. Acute exacerbations, termed hypertensive crises, often lead to emergency department (ED) and clinic visits due to their potential severity. Objective: To assess the prevalence, clinical characteristics, and management patterns of hypertensive crises at a tertiary care center. Design: Retrospective observational study. Setting: Family medicine department (FMD), and the ED at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia. Methods: Records of 408 adult patients (≥18 years) with hypertensive crises (systolic BP ≥180 mmHg and/or diastolic BP ≥110 mmHg) from 2018 to 2022 were reviewed. Data included demographics, symptoms, comorbidities, investigations, management, and discharge outcomes. Statistical analysis was performed using SPSS v23.0; significance was set at p < 0.05. Results: Among 408 patients, 362 (88.7%) presented to the ED and 46 (11.3%) to FMD. The overall prevalence of hypertensive crises was 2.5%. Median systolic BP at presentation was 186 mmHg (ED) and 184 mmHg (FMD). Median age was 66 years; 53.7% were female. Common comorbidities included diabetes (54.9%) and hyperlipidemia (30.2%). Forty-seven patients were newly diagnosed with hypertension. Non-specific symptoms were reported in 39.2%; 12.8% were asymptomatic. Over half did not receive antihypertensive treatment during their visit (51% in ED vs. 39.1% in FMD). Discharge systolic BP remained significantly higher in FMD patients (174 mmHg vs. 151.5 mmHg; p = 0.001). Lack of follow-up appointments was significantly more common among ED patients (48.9% vs. 23.9%, p = 0.005). Conclusions: Most hypertensive crises presented to the ED. Many patients were asymptomatic or had non-specific symptoms and did not receive acute treatment. These findings highlight gaps in immediate and follow-up care, particularly regarding discharge BP control and continuity of care.