Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.

Abstract T3: Type 2 Myocardial Infarction Predicts Outcome In Hypertensive Crisis Patients: Nationwide Analysis

Background: Type 2 Myocardial infarction (T2MI) can occur in hypertensive crisis patients. The impact of T2MI in this population is poorly understood due to limited available data. Objective: To assess the impact of T2MI on patients admitted to the hospital with hypertensive crisis. Methods: We queried National Readmission Database (NRD) of year 2018 for adult patients admitted with a primary diagnosis of hypertensive crisis. Patients were excluded if they had type 1 myocardial infarction (T1MI), septic shock, or bleeding in the index admission. Primary outcome was 90-day readmission due to T1MI. Secondary outcome was in-hospital mortality. Subgroup analysis was done according to urgency and emergency presentation. Multivariate regression was done to account for confounders. Results: A total of 101211 patients were included in our cohort of whom 3644 (3.6%) were diagnosed with T2MI and 24471 (24.2%) were readmitted within 90 days of discharge. Of those, 912 (3.7%) were diagnosed with T1MI on readmission. T2MI was independently associated with increased odds of 90-day readmission with T1MI (Adjusted odds ratio (aOR): 2.67, 95% CI [1.91-3.75], P=0.000). T2MI effect was observed in hypertensive urgency, and in hypertensive emergency. T2MI was associated with increased in-hospital mortality in hypertensive urgency population (aOR: 4.21, 95% [1.58-11.25], P=0.004) but not in hypertensive emergency (table 1). Conclusion: In hypertensive crisis patients, T2MI was associated with increased 90-day readmission with T1MI. Aggressive management of cardiovascular risk factors and risk stratification should be considered at the time of diagnosis.

Abstract P147: Association Between Lipid Transfer To HDL-c And Arterial Stiffness In Patients With Ischemic Stroke Due To Hypertensive Emergency

Objective: To evaluate arterial stiffness (AS) and lipids transfer to high density lipoprotein cholesterol (HDL-c) in ischemic stroke due to hypertensive emergency (IS-HE). Methods: Thirty and one patients with IS-HE, 33 individuals with ischemic stroke without hypertensive emergency (IS), 31 controlled hypertensive (CHT) and 33 normotensive (NT) individuals were studied. AS was assessed by analyzing the pulse wave velocity (PWV), augmentation index and central blood pressure. The lipids transfer to HDL-c was evaluated after incubation of the plasma with an artificial radiolabeled nanoparticle, used as a donor of esterified and non-esterified cholesterol. Cholesterol transfer was measured in the HDL-c fraction, after chemical precipitation of lipoproteins containing apolipoprotein B. Results: Systolic (SBP) and diastolic (DBP) blood pressure were significantly higher in the IS-HE compared to IS, CHT and NT groups (190/110 mmHg vs 140/87, 128/69 and 129/80 mmHg, respectively; p<0.05). Similarly, central SBP and DBP were higher in patients with IS-HE compared to IS, CHT and NT (147/101 mmHg vs 128/90, 118/71 and 120/83 mmHg, respectively; p<0.05). PWV was significantly higher in the groups IS-HE and IS, compared to NT group (9.7 and 10.6 vs 7.8 m/s, respectively; p<0.05). The esterified cholesterol transfer was reduced in the IS-HE and IS groups in relation to the CHT and NT groups (4.19 and 3.76 vs 4.5 and 4.75, respectively; p<0.05). The non-esterified cholesterol transfer was also markedly decreased in IS-HE e IS groups compared to CHT and NT groups (4.57 and 4.06 vs 5.47 and 5.71, respectively; p<0.05). A negative correlation was observed between non-esterified cholesterol transfer and PWV in the IS-HE group. Conclusion: This study provides evidence that high blood pressure levels are associated to arterial stiffness and a marked decrease in the lipids transfer to HDL-c in patients with ischemic stroke due to hypertensive emergency, which indicates that changes in the HDL-c fraction can contribute to atherogenesis in these patients. These considerations contribute to the concept that determining HDL-c functionality with dynamic assays can be relevant for predicting the cardiovascular disease risk.