Hypertensive Emergencies in the Ambulance: Characteristics, Clinical Presentations and Complications - A Prospective Cohort Study.

Abstract

Background: The objective of this study is to describe the characteristics of hypertensive emergencies in Kuwait aiming to provide a preliminary background to update the current guidelines and improve patients' management.

Methods: This is a prospective analysis of hypertensive emergency cases retrieved from emergency medical services (EMS) archived data between 1 January - 30 June 2020. Collected variables included patient characteristics, clinical presentations, vital signs, interventions, and complications. Outcome variable collected was: en route complications.

Results: Hypertensive emergency prevalence in Kuwait is 4.75 per 100,000. Most were non-Kuwaiti (62%) males (59%) with a mean age of 57 ±14 years. Most hypertensive emergency cases occurred at home (62%). The hypertensive emergency BP threshold was; SBP 182 (SD=31) and diastolic BP (DBP) 108 (SD=18). 36% of hypertensive emergency cases had silent hypertension. 67% of hypertensive emergencies were verified using ambulance verification tools. Nitroglycerin was administered to only hypertensive emergencies suspected to have acute coronary syndrome or acute heart failure (50%). Complications were seen in 9.5% of hypertensive emergency cases.

Conclusion: Hypertensive emergency is rare in the ambulance but can progress into a serious situation. One in every 10 hypertensive emergency cases will require en route resuscitation. Hypertensive emergencies should be recognized and managed within their clinical context. The most common clinical presentation of hypertensive emergency is cardiac chest pain. Some pre-hospital verification tools confirm acute HMOD. Further research is required to establish hypertension emergency recognition and management guidelines in the prehospital setting.