Hypertensive crisis: essential hypertension was common.

Clinical bottom line (level 4)

  1. The commonest causes of hypertensive crises were essential hypertension, followed by renovascular problems or diabetic nephropathy.
Bertel et al: British Medical Journal 1983; 286: 19-21
Expires August 2003

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Switzerland

30 patients (aged range 37 to 80 years, ?% male) with very high blood pressure requiring emergency admission (mean blood pressure > 130 mmHg) and one of:
  • hypertensive encephalopathy, intracranial haemorrhage, fundal haemorrhage, unstable angina, diabetic retinopathy, use of oral anticoagulants, severe headache, severe bleeding, dissecting aortic aneurysm, severe congestive heart failure

Patients were treated with nifedipine or clonidine.


Outcomes studied:
  • final diagnosis: essential
  • renovascular
  • neurogenic
  • diabetic nephropathy
  • pheochromocytoma

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    final diagnosis: essential ? 21/30 70%
    (54% to 86%)
    renovascular ? 3/30 10%
    (0.0% to 21%)
    neurogenic ? 2/30 6.7%
    (0.0% to 16%)
    diabetic nephropathy ? 3/30 10%
    (0.0% to 21%)
    pheochromocytoma ? 1/30 3.3%
    (0.0% to 10%)

    Comments

    1. No information was given on how the diagnoses were arrived at.

    Citation

    1. Bertel O, Conen D, Radu EW, et al: nifedipine in hypertensive emergencies. British Medical Journal 1983; 286: 19-21
    Search Terms: hyperten* and urgen* or emergen* in Cochrane
    Contributor: Chris Ball and Clare Wotton, August 2000
    Reviewer:

    Clinical Question.
    Patient hypertensive crisis
    Intervention or Exposure prevalence
    Outcome causes