Care of the hypertensive urgencies and emergencies in the emergency departement.Tunis Med. 2019 Mar; 97(3):468-475.TM
Hypertension is a major public health concern leading to multiple acute complications. The purpose of our work was to present the distribution of high blood pressure (BP) measurements in an emergency department, and their significance.
Our study was prospective, observational and descriptive over a period of one month conducted in the general emergency department. We included non-traumatic patients within 24 hours from the triage. We divided the population into three groups according to the blood pressure measurements at admission; the first group with transient elevation of BP, the second group with hypertensive urgencies and the third group was the group of hypertensive emergencies.
We screened 2011 patients, 460 were included, and the frequency of initial (T0) high blood pressure was 22.8%, controlled at 18.5% after 10 minutes of rest (T10). The mean age was 63.2 ± 13.2 years, the sex ratio was 0.77. The mean blood pressure BP (T0) was 182.1 ± 24.4mmHg [150-280] mmHg for systolic (S) BP, and 86.8 ± 14.7mmHg [60-160] mmHg for diastolic (D) BP. At T10, the mean SBP was 165.1 ± 28.6 mmHg, and DBP was 82.8 ± 12.1mmHg. We started treatment for 32.4% of patients after the third BP control (T30): oral captopril (45.5%), intravenous nicardipine (IV) (27.2%), furosemide (23.9%). During the second BP measurement, there was a significant decrease in average SBP: 21 ± 11mmHg (p <0.001), as well as a significant decrease in average PAD: 3.6 ± 2.4 mmHg (p <0.001). At T30, the decrease was also significant for SBP : 16.5mmHg (p = 0.001), and for BPD : 2.5 mmHg (p = 0.001). The decrease was significant after treatment for SBP : 33.3 mmHg and for DBP: 10.4 mmHg (p = 0.001).
High blood pressure figures are a relatively common in emergencies. The treatment must be chosen according to organ faillure.