Hypertensive crisis profile. Prevalence and clinical presentation.

OBJECTIVE To assess the prevalence of hypertensive crisis, related clinical findings, and the organic lesions involved. METHOD This retrospective study comprised the analysis of the medical records of symptomatic patients with an elevation in diastolic blood pressure levels > or = 120 mmHg, who sought the emergency unit of a university-affiliated hospital over 12 months. Hypertensive urgency was characterized as the symptomatic elevation of blood pressure levels with no evidence of target-organ lesions, and hypertensive emergency was characterized as the symptomatic elevation of blood pressure levels with evidence of acute or ongoing target-organ lesion. RESULTS This study comprised 452 patients with hypertensive crisis, accounting for 0.5% of all clinicosurgical emergencies, of which, 273 (60.4%) were hypertensive urgencies and 179 (39.6%) were hypertensive emergencies. Eighteen percent of the patients ignored their hypertensive condition. Smoking and diabetes were risk factors associated with the development of a hypertensive crisis in 1/4 and 1/5 of the patients, respectively. The patients with a hypertensive emergency were older (59.6+/-14.8 versus 49.9+/-18.6 years, p < 0.001) and had greater diastolic blood pressure (129.1+/-12 versus 126.6+/-14.4 mmHg, p < 0.05) than those with hypertensive urgencies. Ischemic stroke and acute pulmonary edema were the most common hypertensive emergencies, being in accordance with the most frequently found clinical manifestations of neurologic deficit and dyspnea. CONCLUSION Hypertensive crises accounted for 0.5% of all emergency cases studied and for 1.7% of all clinical emergencies, hypertensive urgency being more common than hypertensive emergency. Ischemic stroke and acute pulmonary edema were the most frequent target-organ lesions in hypertensive emergencies.