Incidence, risk factors and outcome of hypertensive crises in critically ill patients: a retrospective survey

Introduction

Hypertensive crises (HC) are common among patients admitted to emergency rooms [1]. However, data are lacking about prevalence in the critically ill admitted to the ICU. The aim of the study was to assess the rate of HC in a cohort of patients admitted to a medical-surgical ICU, to look for risk factors for HC and to assess outcome of patients with HC.

Methods

Data have been collected from clinical charts of patients consecutively admitted to a mixed ICU (1 January 2008 to 31 January 2009). HC diagnosis was made based on JNC definitions [2]. Patients were divided into two groups, the HC group and the control group. Differences between groups were evaluated regarding age, gender distribution, admission diagnosis, SAPS II score, ICU length of stay, ICU mortality, and in-hospital mortality (P < 0.05). Clinical and behavioural conditions associated with HC were considered in the two groups and differences tested for statistical significance (P < 0.05).

Results

Of a total of 409 patients, 63 had one or more HC (15.4%). Conditions significantly associated with HC were age, cigarette smoking, cancer surgery, vasculopathy, medical indication to ICU admission, coronary artery disease, and chronic atrial fibrillation. HC patients showed higher ICU length of stay and ICU mortality.

Conclusions

HC were common among critically ill patients admitted to the ICU, irrespective of their admission diagnosis. Conditions strongly associated with HC included cigarette smoking, cancer and age. HC were associated with worse outcomes.