Hypertensive urgencies during the first wave of COVID-19 pandemic in a tertiary hospital setting: A “U” shaped alarming curve.

IntroductionCorona virus disease (COVID)-19 pandemic provoked unprecedented disturbance in hypertension care, while alarming concerns arose about its long-term consequences. We assessed the impact of COVID-19 spread on population behavior regarding hypertension urgencies during its first wave.Material and methodsData from daily unscheduled visits and admission counts in the Cardiology sector were collected from the Emergency Department database of a tertiary General Hospital in Athens, Greece from January 15th-July 15th 2020. This data was compared with the ones from the previous year. Cases presented with hypertensive urgency or admitted due to uncontrolled hypertension were separately analyzed.ResultsA total of 7,373 patients records were analyzed. Hypertension urgency cases demonstrated a “U” shaped distribution in 2020, showing declining trend during the rapid virus spread, an image that was reversed after the transmission rate’s fade. COVID-19 incidence in Greece was inversely associated with uncontrolled hypertension admissions during its declining phase (r=-0.64 p=0.009), whereas total attendance exhibited a similar correlation during the first and the following months of the pandemic (r=0.677, p=0.031, r=-0.789, p=0.001). Uncontrolled hypertension rate on admission was positively related to the national incidence of COVID-19 cases during the first months of 2020 (r= 0.82, p=0.045).ConclusionsHypertensive urgency-related visits followed a “U” shape distribution during the pandemic’s first wave with attendance nadir coincidence to the virus spread peak. The initial relative increase in uncontrolled hypertension-related admissions rate, combined with the later increment of hypertensive urgencies may indicate blood pressure deregulation among the studied population which is multifactorial and potentially detrimental.

Caracterización de las Crisis Hipertensivas en adultos de la Emergencia del Hospital José Félix Valdivieso, Enero 2016 a Diciembre 2018

BACKGROUND: Hypertensive crisis is considered an acute complication of Hypertension, causing 9.4 million deaths annually. Another important problem is the resulting morbidity. Locally, data is limited, that is the importance of presenting the clinical and epidemiological characteristics of hypertensive crisis. The aim of this study was characterizing hypertensive crisis in adults, in Hospital José Félix Valdivieso, Santa Isabel, from January 2016 to December 2018. METHODS: Descriptive, cross-sectional study, the study universe were 151 patients diagnosed with hypertensive crisis in Hospital José Félix Valdivieso from January 2016 to December 2018, by simple random sampling we picked 122 patients. The information was obtained from the patient’s medical chart. The data was processed using Excel 2016, and later interpreted using tables and charts. RESULTS: 57% of the sample were female, 49% had between 40 to 65 years of age, 67% had primary education, 65% came from rural areas. About risk factors; 50% of the population was overweight, 70% had previous diagnosis of hypertension. About the type of hypertensive crisis; 93% were hypertensive urgencies, the most commonly affected organ in hypertensive emergencies was the brain, in 89% of the cases. Headache, was the most frequent symptom(59%), followed by neurological symptoms. Captopril was used as initial treatment in 61% of the cases. CONCLUSION: The majority of affected patients were female, middle aged adults. Most of the sample had overweight or obesity. 70% of the population had previous diagnosis of hypertension, of this patients only 80% had hypertensive treatment. Most of the crisis were hypertensive urgencies, in hypertensive emergencies the most commonly affect organ was the brain. Captopril was used in most of the cases for initial treatment. This study didn’t registered any deaths.

THE ROLE OF ANXIOLYTICS IN HYPERTENSIVE URGENCY MANAGEMENT

Current guidelines do not cover hypertensive urgency management in out-of-hospital setting. Main goal of this study was to evaluate the value of anxiolytic therapy in hypertensive urgencies. We analyzed data gathered by out of-hospital unit set up during one year. Arterial hypertension was the primary diagnosis in 178 (6.11%) patients, of whom 144 had hypertensive urgency with mean SBP reduction 19.5±7.2%; control group 10.1±6.9%. Anxiolytic therapy was administered in 60% of patients in hypertensive urgency group, and they had a statistically significant greater SBP reduction (p=0.03) than patients who did not receive anxiolytic therapy. There is a place for anxiolytic therapy in hypertensive urgency management.

Hypertensive urgencies and emergencies

Hypertensive urgencies and emergencies occur most commonly in patients with previous hypertension, especially if inadequately managed. About 40% of cases have an underlying cause, most commonly renovascular disease, primary renal diseases, phaeochromocytoma, and connective tissue disorders. Hypertensive emergencies occur when severely elevated or sudden marked increase in blood pressure is associated with acute end-organ damage. Malignant phase hypertension is a rare condition characterized by very high blood pressure, with bilateral retinal haemorrhages and/or exudates or cotton wool spots, with or without papilloedema. Presentation is typically with visual disturbance, with or without headaches. Urinalysis may demonstrate proteinuria and haematuria, even in the absence of primary renal disease. Some patients with mild renal impairment at first presentation may improve, or even regain normal renal function, but this is unlikely to occur in those with more severe renal impairment at presentation.