title: Incidence, aetiology and mortality secondary to hypertensive emergencies in a large-scale referral centre in Israel (1991-2010).
abstract: Hypertensive emergency (HE) is a life-threatening condition that requires immediate blood pressure (BP) reduction. Although it has been on the decline, the incidence of HE has recently increased in a few countries. The aim of the present retrospective study was to evaluate the incidence, aetiology and 1-year mortality of HE in a large medical centre over a 20-year period (1991-2010). The electronic medical records of all patient files who were hospitalized in the Chaim Sheba Medical Center in Israel from 1991 to 2010 with a primary diagnosis (at admission or discharge) of Malignant Hypertension, Hypertensive Emergency or Accelerated Hypertension were retrieved and analysed. The study interval was divided into four periods of 5 years each. Among 306 files reviewed, only 142 patients had a true HE. Average age at presentation was 63.3±16.5 years. Men were younger than women (59±16 vs 68±16 years; P<0.001). At presentation, most patients (80.3%) had been diagnosed with essential hypertension previously and were undertreated. Average maximum mean arterial pressure (MAP) was higher in men (169±22 mm Hg) than in women (161±17 mm Hg; P=0.026). The rate of HE decreased over the course of the study, from 12.7/100 000 admissions during 1991-1995 to 6.2/100 000 admissions (2006-2010). Similarly, 1-year mortality decreased from 16.7 to 3.6%. The rate of HE has decreased and the prognosis has improved over the last two decades. Appropriate BP control of patients with essential hypertension may further decrease the risk of HE.
authors.affiliation: Nephrology and Hypertension Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Medicine and Medical Education, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Leiba
authors.affiliation: Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Cohen-Arazi
authors.affiliation: Omnistat Statistical Consulting, Tel Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Mendel
authors.affiliation: Nephrology and Hypertension Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: E J
authors.initials: EJ
authors.lastname: Holtzman
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure / Q000187:drug effects; D057286:Electronic Health Records; D004630:Emergencies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006974:Hypertension, Malignant / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents