The Relationship Between Hypertensive Crisis and Patient Outcome

We read the article “Patients With Hypertensive Crises Who Are Admitted to a Coronary Care Unit: Clinical Characteristics and Outcomes” written by Hector Gonzalez Pacheco and colleagues with interest.1 The authors concluded that hypertensive emergency (HTN-E) was associated with the worst mortality outcomes in patients who were admitted to a coronary care unit, and pattern of predominant systolic hypertension (sHTN) was most commonly observed in the study group.1 We thank the authors for their contribution of the study, which was successfully designed and documented. We believe that these findings will enlighten further studies about hypertensive crises (HTN-C) and its role in patient outcome. Hypertension, an important member of chronic noncommunicable diseases, is a major global public health problem that must be evaluated by each country2 so that prevention measures can be increased and cases of HTN-C can consequently be reduced. Patients with HTN-E are best treated in an intensive care unit with titratable intravenous hypotensive agents.3 The present study shows that the frequent use of intravenous vasodilators in patients with hypertensive urgency (HTN-U) was striking, and that the inappropriate use of intravenous antihypertensive agents is potentially dangerous in those patients. We thank the authors for highlighting this important problem. In the present study, patients were divided into 3 groups according to their blood pressure (BP) values (group I, predominant systolic hypertension; group II, severe systolic and diastolic hypertension; and group III, predominant diastolic hypertension) and the pattern of sHTN was most commonly observed in the HTN-C and HTN-E groups. We think the reason for this is that a number of patients were older than 60 years. As we know, there is an inexorable increase in systolic BP with aging.4 In addition, we think that stratification of patients according to the type of BP would give useful information in the management of HTN-C. There is also some confusion in the present study. The authors make an assumption about the worst mortality outcomes in HTN-E, and we think that the main reason of the worst mortality outcome is to perform the study in the coronary care unit, because coronary care unit mortality is always high. The authors suggested that the retrospective nature of the study and confounding acute comorbidities were associated with the worst mortality outcomes in HTN-E. We think this inference is true, but the main reason is to perform the study in the coronary care unit.