Assessing the impact of acute severe hypertension in the emergency department: A prospective cohort study in Karachi, Pakistan

Junaid A Razzak; Noman Ali; Uzma Khan; Madiha Ismail; Badar Afzal Khan; Ahmed Raheem; Priyanka Agrawal; Junaid Bhatti

doi:10.1371/journal.pgph.0003948

Assessing the impact of acute severe hypertension in the emergency department: A prospective cohort study in Karachi, Pakistan

PLOS Glob Public Health. 2024 Dec 4;4(12):e0003948. doi: 10.1371/journal.pgph.0003948. eCollection 2024.

Authors

Junaid A Razzak^{1

2}, Noman Ali², Uzma Khan², Madiha Ismail², Badar Afzal Khan², Ahmed Raheem², Priyanka Agrawal³, Junaid Bhatti⁴

Affiliations

¹ Department of Emergency Medicine, Weill Cornell Medicine New York, New York, NY, United State of America.
² Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
³ Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, United State of America.
⁴ Manulife Canada, Toronto, Ontario, Canada.

Abstract

Acute Severe Hypertension (ASH), presenting as a Hypertensive Emergency (HE) or Hypertensive Urgency (HU), is a frequent reason for emergency department (ED) admissions. This study sought to assess the prevalence of ASH among adult ED patients in Pakistan and investigate all-cause mortality and hospitalization rates over six months. We conducted a prospective single-center cohort study in Karachi, Pakistan, from June 3, 2019, to September 22, 2020. We enrolled all adult male and non-pregnant female patients presenting to the emergency department with a systolic blood pressure of ≥180 mm Hg or diastolic blood pressure of ≥120 mm Hg. Telephonic follow-ups were conducted at one, three-, and six months post-discharge from the hospital. The Cox Regression Model was used to identify the risk factors for mortality. Of 49,431 ED visits during the study period, 1,525 (3.1%) met the inclusion criteria, and 1,161 (76.2%) were enrolled. A total of 356 patients (30.6%) were diagnosed with HE, and 805 (69.2%) with HU. Among follow-up patients, 14.6% with HE and 4.7% with HU experienced mortality within six months. Notably, the risk of mortality was higher in patients aged >65 years (aRR = 1.90, 95% CI = 1.20 to 3.02) and those suffering from stroke (aRR = 2.09, 95% CI = 1.21 to 3.61) or acute kidney injury (aRR = 1.82, 95% CI = 1.09 to 3.04). Conversely, regular blood pressure monitoring (aRR = 0.08, 95% CI = 0.03-0.19) and adherence to antihypertensive medications (aRR = 0.23, 95% CI = 0.09-0.56) significantly lowered the risk HE resulted in heightened mortality at six months, while HU, traditionally deemed benign, also led to substantial morbidity and mortality. This underscores the ED visit for ASH as a crucial opportunity for preventing short-term and longer-term health complications.

Copyright: © 2024 Razzak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW011175 to JR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.