Prevalence of true hypertensive crises and appropriateness of the medical management in patients with high blood pressure seen in a general emergency room.
BACKGROUND
High blood pressure is a common reason for patients to seek an emergency room, and many of them may possibly be wrongly diagnosed with hypertensive crisis and, consequently, be inappropriately treated.


OBJECTIVE
To analyze the cases of patients seen in a general emergency room because of high blood pressure as for meeting the criteria for the diagnosis of hypertensive crisis and the appropriateness of medical management.


METHODS
Of the 1012 patients consecutively seen in a private referral general emergency room in the city of São Luís, State of Maranhão, between August and November 2003, 198 (19.56%) had a main diagnosis of high blood pressure in that visit. Of these, proper information could only be obtained from the patient charts of 169 patients; 54.4% of them were females with a mean age of 53.3 +/- 15.2 years. Data regarding patients and the attendant physicians were collected, and each case was classified as an urgency, emergency or pseudohypertensive crisis; the medical management was classified as appropriate or inappropriate. We also sought to identify the factors associated with the medical management and with the use of antihypertensive medication.


RESULTS
Criteria for the characterization of a hypertensive crisis were present in only 27 patients (16%), and all were classified as urgencies. Medical management was considered appropriate in 72 cases (42.6%), and was neither influenced by specialty (p=0.5) nor by the physician's experience (p=0.9). Blood pressure levels, but not the presence or absence of symptoms, were predictive of the use of antihypertensive medication (p<0.001).


CONCLUSIONS
In the population analyzed, less than one fifth of the patients seen in an emergency room with a presumed hypertensive crisis met defined criteria for this diagnosis. Medical management was considered appropriate in less than half of the occurrences.
Universidade Federal do Maranhão, São Luís, MA - Brasil. francchagas@cardiol.br
Francisco das Chagas
Fd
Monteiro Júnior
Fernando Antônio Costa
FA
Anunciação
Natalino
N
Salgado Filho
Genise Mayara Alves da
GM
Silva
José Bonifácio
JB
Barbosa
Pedro Antônio Muniz
PA
Ferreira
Joyce
J
Lages
Natália Ribeiro
NR
Mandarino
Wellington Santana da
WS
Silva Júnior
Carolina Cipriano
CC
Monteiro
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence
D000959:Antihypertensive Agents