Abstract

RODRIGUEZ, Pablo et al. Severe Hypertension in Emergency Department Survey: Population Characteristics and Response to a Handling Guideline: The REHASE Study. Rev. argent. cardiol. [online]. 2006, vol.74, n.3, pp.102-108. ISSN 1850-3748.

Work Aim To assess the prevalence of severe hypertension (SHT) in the emergency department (ED); evaluate patient's characteristics and the efficacy of a clinical practice guideline (CPG) based on a normative guideline published by the Argentine Hypertension Council, Argentine Society of Cardiology. Design and Methods Patients presenting with SHT to 31 different ED were included. The study was divided into 2 phases: a whole population statistical data acquisition phase (Phase I) and an interventional phase (Phase II) which only included patients without acute target organ damage (ATOD). Patients in the latter phase underwent a CPG that consecutively included rest and randomly assigned antihypertensive drugs with different mechanisms and onset of action (amlodipine 10 mg; labetalol 200 mg, or perindopril 4 mg). Results 816 patients were included (60.4±14.7 years old; 50.4% male; 87.4% without ATOD). The estimated prevalence of SHT was 9%. Previous hypertension (HT) was identified in 83.46%. Among those with previously known HT, 86.23% were on antihypertensive drug treatment and their SBP was >150 mm Hg. Satisfactory response to rest was observed in 32% of the population. Among non-responders, 79.14% showed a satisfactory response to antihypertensive drug treatment. Considered safety parameters were: mean blood pressure (MBP) reduction > 20% from baseline and a smaller account or absence of adverse events in the ED. A reduction in MBP >20% was observed in 5.6% of rest responders and 15.9% of those who received drug treatment. No related events were observed in the ED. Conclusion The present survey provided a clinical characterization of SHT patients and suggests that the proposed CPG can be an efficient and safe alternative.

Keywords : Severe hypertension; Hypertensive urgency; Hypertensive emergency; Rest.