P-438: Prognostic impact of hypertensive urgencies on cardiovascular events

• Published in: American journal of hypertension 2004-05, Vol.17 (S1), p.194A-194A
• Main Authors: Bur, Andreas, Herkner, Harald, Vlcek, Marianne, Woisetschlaeger, Christian, Laggner, Anton N., Hirschl, Michael M.
• Format: Article
• Language: English
• Subjects: Cardiovascular Event; Hypertensive Urgency; Prognostic Impact
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2004.03.512

Purpose of the study was to evaluate the prognostic impact of hypertensive urgencies on cardiovascular events. The study was performed at the Hypertension Unit of the Department of Emergency Medicine in Vienna. Inclusion criteria were diagnosis of hypertensive urgency defined as blood pressure over 210 and/or 120 mm Hg without signs of end organ damage or uncontrolled hypertension defined as blood pressure at and over 140 and/or 90 mm Hg but below 210 and/or 120 mm Hg on admission. Patients with secondary hypertension were excluded. The incidence of cardiovascular events during follow-up was recorded. Overall 679 patients (332; 49% female) divided in 384 (57%) patients with hypertensive urgency and 295 (43%) patients with uncontrolled hypertension could be enrolled into the study. Patients with hypertensive urgencies were older (56 vs. 50 years; p=0.0001) had a higher frequency of left ventricular hypertrophy (p=0.024), a higher rate of microalbuminuria (p=0.013), dyslipidemia was more frequent (p=0.038) and more patients were unaware of hypertension (21% vs. 15%; p=0.026). Clinic systolic and diastolic blood pressure values were significantly higher in patients with hypertensive urgency (p=0.0001 and 0.008, respectively). Median time of observation was 4.2 years (IQR 2.9–5.7 years). During the period of follow-up blood pressure control, defined as blood pressure values below 140 and 90 mm Hg was achieved in 197 (51%) patients after hypertensive urgency and in 169 (57%) patients with primarily uncontrolled hypertension (p=0.121). Overall 117 (17%) patients had non-fatal clinical cardiovascular event and 13 (2%) patients died of cardiovascular reason. We found a statistically significant higher frequency of cardiovascular events in the patients with hypertensive urgency (p=0.04). In a cox regression analysis including hypertensive urgency, age, left ventricular hypertrophy, clinical blood pressure, microalbuminuria, dyslipidemia, and unknown hypertension only age (p=0.0001) and hypertensive urgency (p=0.029) were independent predictors of cardiovascular events. In conclusion patients with hypertensive urgency had a higher rate of major risk factors and target organ damage in comparison to patients with uncontrolled hypertension. Nevertheless besides age, hypertensive urgency per se seemed to be an independent predictor for the incidence of cardiovascular events in hypertension. Am J Hypertens (2004) 17, 194A–194A; doi: 10.1016/j.amjhyper.2004.03.512