L Myat, E Shao, A Khoo and Y Wee
The Prince Charles Hospital, Australia
Scientific Tracks Abstracts: J Clin Exp Cardiolog
Background: Hypertensive Crisis (HC) is a common clinical presentation and hypertension is a major modifiable cardiovascular risk factor. Management includes several effective Blood Pressure (BP) lowering strategies, prevention of target organ dysfunction and further cardiovascular disease risk assessment. Methods: We conducted a retrospective review of HC admissions during 2016 at The Prince Charles Hospital. Data extraction was performed from the integrated electronic medical records and charts. Results: We reviewed 84 patients with about half (n=40, 47%) directly discharged from emergency department. Among those managed as inpatient, ten patients had hypertensive emergency; scleroderma renal crisis (n=1), hypertensive encephalopathy (n=3), acute dyspnoea (n=6). The rest of largely asymptomatic patients were categorized as hypertensive urgency. Transdermal glyceryl trinitrate is the most commonly used therapy with other oral agents; amlodipine and hydralazine. One patient required vasopressor therapy for hypotension after receiving three different agents (GTN, amlodipine and clonidine). 22 patients (26.19%) had previously untreated hypertension. Average length of stay was 2.41 days. At one year, seven patients (8.33%) were readmitted with HC. Major cardiovascular events occurred in 8 patients; congestive cardiac failure (CCF, n=3) and cerebrovascular accident (CVA, n=5). Chronic resistant hypertension made 21.42% (n=18) of this cohort and most of representers with adverse outcomes (HC n=2, CCF n=1, CVA n=2) Conclusion: The majority had hypertensive urgency and long standing poorly managed hypertension. Rapid BP reduction in these patients might lead to adverse consequences. HC is the turning point for blood pressure trajectory at which acute management of the elevated BP could improve the short-term and long-term prognosis.
Lin Lin Myat has completed her MBBS from University of Medicine, Mandalay in Myanmar. She is currently an Internal Medicine Advanced Trainee with Royal Australian College of Physician. His career interest is in hypertension and cardiovascular medicine.