What is the clinical evidence from this study?

Study design: Observational. Population: Hypertensive crisis (n=169). Primary outcome: 24-hour mortality.

What does this research mean for the field?

Hypertensive crisis occurs in 63 per 1000 adult patients presenting to emergency departments in Tanzania, with a 24-hour mortality of 1.8%, and is independently driven by increasing age, illicit drug use, and pre-existing hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2023Open Access

The burden and management strategies of hypertensive crisis in adult patients presenting to emergency departments of district and regional hospitals in Sub-Saharan Africa

Key Result

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.

Study Design

Type

Observational (n=169)

Multicenter

Yes

Structured PICO

Population

169 adult patients (≥18 years) presenting to emergency departments of 162 district and regional hospitals in Tanzania with blood pressure ≥ 180/110mmHg. Median age 62 years, 66.3% female.

Outcome

24 h mortalityhard clinical

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.

Limitations

Collecting data for one day (24 h) at each hospital might not include daily or seasonal variation of flow of patients attending ED
Did not follow up to see the blood pressure changes at 24 h after admission

Abstract

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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