J Med Assoc Thai 2010; 93 (1):54

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Hypertensive Emergencies Remain a Clinical Problem and are Associated with High Mortality
Roubsanthisuk W Mail, Wongsurin U , Buranakitjaroen P

Objective: We suspect that hypertensive emergencies remain a clinical problem and data on their long-term
prognosis are lacking. This study was conducted in order to determine the frequency, management, and
outcome of hypertensive emergencies in this era, in which hypertension treatment is more effective than in the
past.

Material and Method:
We reviewed the medical records of patients with hypertensive emergencies admitted to
the medical wards of Siriraj Hospital in 2003 and collected data on their characteristic, management, investigations,
and follow-ups through 31 December 2007.

Results: There were 184 patients included. Hypertension has been previously diagnosed in 89% of cases.
Nearly half also had diabetes mellitus and around a quarter had chronic kidney failure. Mean + SD of blood
pressure at presentation was 205.96 + 21.36/114.60 + 20.59 mmHg. Cardiac complications and stroke
accounted for 71% and 23% of all target organ damage, respectively. Intravenous nitroglycerine and furosemide
were most frequently prescribed. Additional investigations to search for the causes of hypertension
were performed in only 55 cases. The average hospital stay was 9.8 days. The in-hospital mortality rate was
15%. Some 26% of patients were lost to follow-up and another 20% died later. Only 19% of patients had
regular follow-ups until the end of 2007 and remained on an average of 2.4 antihypertensive drugs.

Conclusion: Hypertensive emergencies are usually found in patients with a history of hypertension and
diabetes mellitus or kidney failure. Recommended investigations usually failed to identify the cause of hypertension.
The mortality rate of these patients was extremely high while their adherence to treatment was
extremely poor.

Keywords:
Hypertension, Emergencies, Diabetes mellitus, Kidney failure, Heart failure

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