The following is a summary of “Prevalence of neurological complaints among emergency department patients with severe hypertension,” published in the December 2022 issue of Emergency Medicine by Liberman, et al.
Neurological symptoms may be accompanied by severe hypertension, even without clear target organ damage. However, significant hypertension can both induce and result from acute cerebrovascular episodes. For a study, researchers sought to ascertain the frequency and clinical characteristics of individuals with severe hypertension and neurological symptoms; they thus used population-level data from the US.
They identified adult ED patients with extremely high blood pressure (BP), defined as systolic BP ≥180 mmHg and/or diastolic BP ≥120 mmHg, using nationally representative data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected in 2016-2019. In addition, neurological symptoms were defined using ED reason for visit data fields, and acute target organ injury was defined using diagnostic data fields. To get national figures, they applied weights based on survey visitation.
Based on 5,083 data, from 2016 to 2019, 6.1% (95% CI: 5.7-6.5%) of all ED visits were for patients with severe hypertension, or 40.4 million patients (95% CI: 37.5-43.0 million). Only 2.8% (95% CI: 2.0-3.9%) of ED patients with severe hypertension had an acute cerebrovascular illness, while 92.0% (95% CI: 90.3-93.4%) had hypertensive urgency. Both patients with (75.6%) and without (19.9%) cerebrovascular diagnoses reported having frequent neurological problems. In comparison to patients without these symptoms, hypertensive urgency patients with neurological issues were often older, female, and had a history of stroke or TIA. Vertigo and non-migraine headaches were the two most prevalent neurological symptoms.
One in sixteen ED patients in a nationally representative sample had significantly raised blood pressure, and one-fifth of those patients reported neurological problems.