%0 Journal Article
%T Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi
%A Aysha Almas
%A Ayaz Ghouse
%A Ahmed Raza Iftikhar
%A Munawwar Khursheed
%J International Journal of Chronic Diseases
%D 2014
%R 10.1155/2014/413071
%X Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18£¿yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm£¿Hg and on per oral treatment was 43 (27) mm£¿Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm£¿Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup. 1. Background Hypertension is a common chronic medical condition affecting people in Pakistan and the rest of the world [1]. It is an important modifiable risk factor for cardiovascular morbidity and mortality, particularly for stroke (accounting for 51% of all stroke deaths worldwide), ischemic heart disease (45% of all deaths), chronic kidney disease, congestive heart failure, aortic aneurysm, and peripheral arterial disease [2]. Prevalence of hypertension (systolic blood pressure >140£¿mm Hg or diastolic blood pressure >90£¿mm Hg, or on antihypertensive medications) in Pakistan has increased from 17% in 1980 to 35% in 2008 in adults aged 18 years and older [3]. The increasing prevalence of hypertension together with a deficient control makes this one of the frequent conditions that require urgent medical attention [4]. The prevalence of uncontrolled hypertension varies around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women) [5]. Recent population based data for control rates of hypertension from Pakistan are not available. However, the control of hypertension was 23% from a community based data in urban population from Karachi, Pakistan [6]. Uncontrolled hypertension can progress to
%U http://www.hindawi.com/journals/ijcd/2014/413071/