To test the hypotheses that hypertensive emergency was associated with non-compliance with antihypertensive medication, low level of contact with the medical care system, and alcohol abuse and cigarette smoking. Also, to describe the clinical characteristics of patients hospitalized with hypertensive emergency including morbidity, mortality, and cost, and the extent to which hypertensive emergency occured among previously diagnosed and treated hypertensives.

BACKGROUND:

While less frequent than in the era before effective treatment for hypertension, hypertensive emergency remains a relatively common cause of hospital admission in some sub-populations. In 1989, hypertensive emergency accounted for approximately 60 admissions per year to the Medical Service at Presbyterian Hospital, and a somewhat higher proportion of intensive care unit admissions and utilization. The importance of hypertensive emergency may have been underestimated because the International Classification of Diseases discharge codes included only malignant hypertension, a severe form comprising only about half of the admissions for hypertensive emergency. There had been almost no epidemiologic studies of hypertensive emergency since 1969, and very little was known about risk factors.

DESIGN NARRATIVE:

A matched case-control study design was used. Cases were obtained from admissions to the Medical Service at Presbyterian Hospital. Morbidity and mortality data were obtained by follow-up of the case series.

Inclusion criteria

1. Patients admitted in the emergency room and for the medical and surgical services at the Presbyterian Hospital and Harlem Hospital Center in New York City

• patients with incidents of hypertensive emergency or hypertensive urgency
• hypertensive patients with other acute conditions who were admitted to the hospital or were treated in the emergency room and released

Exclusion criteria

1. Under 21 years of age
2. Pregnancy

Subjects were enrolled in a case-control study of hypertensive emergency and urgency. Cases were patients with incidents of hypertensive emergency or hypertensive urgency, and controls were hypertensive patients with other acute conditions who were admitted to the hospital or were treated in the emergency room and released.