Pinna Giuliano, Pascale Claudio, Fornengo Paolo, Arras Sebastiana, Piras Carmela, Panzarasa Pietro, Carmosino Gianpaolo, Franza Orietta, Semeraro Vincenzo, Lenti Salvatore, Pietrelli Susanna, Panzone Sergio, Bracco Christian, Fiorini Roberto, Rastelli Giovanni, Bergandi Daniela, Zampaglione Bruno, Musso Roberto, Marengo Claudio, Santoro Giancarlo, Zamboni Sergio, Traversa Barbara, Barattini Maddalena, Bruno Graziella
Department of Internal Medicine, Ospedale Cottolengo, Torino, Italy.
Department of Medical Sciences, Univerity of Torino, Torino, Italy.
PLoS One. 2014 Apr 2;9(4):e93542. doi: 10.1371/journal.pone.0093542. eCollection 2014.
Epidemiological data on the impact of hypertensive crises (emergencies and urgencies) on referral to the Emergency Departments (EDs) are lacking, in spite of the evidence that they may be life-threatening conditions. We performed a multicenter study to identify all patients aged 18 years and over who were admitted to 10 Italian EDs during 2009 for hypertensive crises (systolic blood pressure ≥220 mmHg and/or diastolic blood pressure ≥120 mmHg). We classified patients as affected by either hypertensive emergencies or hypertensive urgencies depending on the presence or the absence of progressive target organ damage, respectively. Logistic regression analysis was then performed to assess variables independently associated with hypertensive emergencies with respect to hypertensive urgencies. Of 333,407 patients admitted to the EDs over the one-year period, 1,546 had hypertensive crises (4.6/1,000, 95% CI 4.4-4.9), and 23% of them had unknown hypertension. Hypertensive emergencies (n = 391, 25.3% of hypertensive crises) were acute pulmonary edema (30.9%), stroke (22.0%,), myocardial infarction (17.9%), acute aortic dissection (7.9%), acute renal failure (5.9%) and hypertensive encephalopathy (4.9%). Men had higher frequency than women of unknown hypertension (27.9% vs 18.5%, p<0.001). Even among known hypertensive patients, a larger proportion of men than women reported not taking anti-hypertensive drug (12.6% among men and 9.4% among women (p<0.001). Compared to women of similar age, men had higher likelihood of having hypertensive emergencies than urgencies (OR = 1.34, 95% CI 1.06-1.70), independently of presenting symptoms, creatinine, smoking habit and known hypertension. This study shows that hypertensive crises involved almost 5 out of 1,000 patients-year admitted to EDs. Sex differences in frequencies of unknown hypertension, compliance to treatment and risk of hypertensive emergencies might have implications for public health programs.
尽管有证据表明高血压危象（急症和次急症）可能危及生命，但关于其对急诊科室（ED）转诊影响的流行病学数据却很缺乏。我们进行了一项多中心研究，以确定2009年期间因高血压危象（收缩压≥220mmHg和/或舒张压≥120mmHg）入住10家意大利急诊科室的所有18岁及以上患者。我们根据是否存在进行性靶器官损害，将患者分别归类为受高血压急症或高血压次急症影响。然后进行逻辑回归分析，以评估与高血压急症相对于高血压次急症独立相关的变量。在一年期间入住急诊科室的333407名患者中，1546名患有高血压危象（4.6/1000，95%可信区间4.4 - 4.9），其中23%患有不明高血压。高血压急症（n = 391，占高血压危象的25.3%）包括急性肺水肿（30.9%）、中风（22.0%）、心肌梗死（17.9%）、急性主动脉夹层（7.9%）、急性肾衰竭（5.9%）和高血压脑病（4.9%）。不明高血压的男性发生率高于女性（27.9%对18.5%，p<0.001）。即使在已知高血压患者中，报告未服用抗高血压药物的男性比例也高于女性（男性为12.6%，女性为9.4%，p<0.001）。与年龄相仿的女性相比，男性发生高血压急症而非次急症的可能性更高（比值比=1.34，95%可信区间1.06 - 1.70），与呈现的症状、肌酐、吸烟习惯和已知高血压无关。这项研究表明，高血压危象涉及每1000名急诊入院患者年中近5例。不明高血压发生率、治疗依从性和高血压急症风险方面的性别差异可能对公共卫生项目有影响。
