ABSTRACT
Introduction: Hypertensive emergencies and urgencies represent a frequent challenge for physicians in Emergency Department. Rapid and careful assessment of the clinical presentation is crucial in order to allow prompt recognition of Hypertensive Emergencies that require appropriate treatment targeted to the affected organ(s). Aim(s): to evaluate the prevalence, clinical presentation and treatment of patients admitted for hypertensive emergencies or hypertensive urgencies in ED. Method(s): Medical records of consecutive patients aged at least 18 years, admitted to the ED of "Antonio Cardarelli"' hospital in Naples (Italy) over a one month period and presenting with SBP at least 180 mmHg and/or DBP at least 110 mmHg were prospectively analyzed. Result(s): We screened 3500 patients and enrolled 63 (1.8%). The mean age of the participants was 65 +/- 13 and 65% were men. 73% of the patients had hypertension, 25% had coronary heart disease and 19 % diabetes. Overall, 31 had hypertensive emergency and 32 had hypertensive urgency. Five patients (8%) tested positive for Covid 19 infection, all hospitalized for hypertensive emergency. Among hypertensive emergencies, the different forms of organ damage were: acute coronary syndrome (39%), abdominal aorta fissure (3.2%), acute heart failure (23%), hemorrhagic stroke (16%) and ischemic stroke (19%). SBP values and heart rate (HR) were higher in patients with emergencies than in those with urgencies (BP 195 +/- 17 vs 186 +/- 24 mmHg and 93 +/- 20 vs 83 +/- 22 bpm), but the analysis showed no statistically significant differences between the two groups. (p = 0.12 and p = 0.087 respectively). Chest pain was the most common presenting symptom in hypertensive emergency (42%) followed by neurological deficit (35%) and dyspnoea (22.6%). Patients with hypertensive urgencies were prevalently asymptomatic (29%) o presented headache (28%). Twelve patients with hypertensive emergency (38.7%) were assigned a yellow code. Mortality was 8%;they were admitted for hypertensive emergency and 3 of the 5 deceased patients were affected by SARS COVID 19 infection. Conclusion(s): The high prevalence of hypertensive emergency can be explained as our hospital is a reference center for percutaneous coronary intervention and stroke. Covid infection may have adversely affected the prognosis of patients with hypertensive emergency.