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Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis.
J Hypertens. 2020 07; 38(7):1203-1210.JH

Abstract

OBJECTIVES

The prevalence of hypertensive emergencies and urgencies and of acute hypertension-mediated organ damage (aHMOD) in emergency departments is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of hypertensive emergencies and hypertensive urgencies in emergency departments and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD.

METHODS

We conducted a systematic literature search on PubMed, OVID, and Web of Science from their inception to 22 August 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis.

RESULTS

Eight studies were analysed, including 1970 hypertensive emergencies and 4983 hypertensive urgencies. The prevalence of hypertensive emergencies and hypertensive urgencies was 0.3 and 0.9%, respectively [odds ratio for hypertensive urgencies vs. hypertensive emergencies 2.5 (1.4-4.3)]. Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorrhagic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. Hypertensive urgency patients were younger than hypertensive emergency patients by 5.4 years and more often complained of nonspecific symptoms and/or headache, whereas specific symptoms were more frequent among hypertensive emergency patients.

CONCLUSION

Hypertensive emergencies and hypertensive urgencies are a frequent cause of access to emergency departments, with hypertensive urgencies being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Astarita A
Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin.
Covella M
Emergency Department, U.Parini Hospital, Aosta.
Vallelonga F
Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin.
Cesareo M
Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin.
Totaro S
Emergency Division, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin.
Ventre L
Ophthalmology Division, 'Città della Salute e della Scienza' University Hospital, Turin.
Aprà F
High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy.
Veglio F
Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin.
Milan A
Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, AO 'Città della Salute e della Scienza' University Hospital, Turin.

MeSH

Acute Coronary SyndromeAntihypertensive AgentsBlood PressureEmergency MedicineEmergency Service, HospitalHeart FailureHumansHypertensionHypertension, MalignantHypertensive EncephalopathyIschemic StrokeOdds RatioPrevalencePulmonary EdemaStroke

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32510905

Citation

Astarita, Anna, et al. "Hypertensive Emergencies and Urgencies in Emergency Departments: a Systematic Review and Meta-analysis." Journal of Hypertension, vol. 38, no. 7, 2020, pp. 1203-1210.
Astarita A, Covella M, Vallelonga F, et al. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. J Hypertens. 2020;38(7):1203-1210.
Astarita, A., Covella, M., Vallelonga, F., Cesareo, M., Totaro, S., Ventre, L., Aprà, F., Veglio, F., & Milan, A. (2020). Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. Journal of Hypertension, 38(7), 1203-1210. https://doi.org/10.1097/HJH.0000000000002372
Astarita A, et al. Hypertensive Emergencies and Urgencies in Emergency Departments: a Systematic Review and Meta-analysis. J Hypertens. 2020;38(7):1203-1210. PubMed PMID: 32510905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. AU - Astarita,Anna, AU - Covella,Michele, AU - Vallelonga,Fabrizio, AU - Cesareo,Marco, AU - Totaro,Silvia, AU - Ventre,Luca, AU - Aprà,Franco, AU - Veglio,Franco, AU - Milan,Alberto, PY - 2020/6/9/entrez PY - 2020/6/9/pubmed PY - 2021/5/18/medline SP - 1203 EP - 1210 JF - Journal of hypertension JO - J Hypertens VL - 38 IS - 7 N2 - OBJECTIVES: The prevalence of hypertensive emergencies and urgencies and of acute hypertension-mediated organ damage (aHMOD) in emergency departments is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of hypertensive emergencies and hypertensive urgencies in emergency departments and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD. METHODS: We conducted a systematic literature search on PubMed, OVID, and Web of Science from their inception to 22 August 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis. RESULTS: Eight studies were analysed, including 1970 hypertensive emergencies and 4983 hypertensive urgencies. The prevalence of hypertensive emergencies and hypertensive urgencies was 0.3 and 0.9%, respectively [odds ratio for hypertensive urgencies vs. hypertensive emergencies 2.5 (1.4-4.3)]. Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorrhagic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. Hypertensive urgency patients were younger than hypertensive emergency patients by 5.4 years and more often complained of nonspecific symptoms and/or headache, whereas specific symptoms were more frequent among hypertensive emergency patients. CONCLUSION: Hypertensive emergencies and hypertensive urgencies are a frequent cause of access to emergency departments, with hypertensive urgencies being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/32510905/Hypertensive_emergencies_and_urgencies_in_emergency_departments:_a_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -