Prevalence of cardiovascular events in patients with hypertensive urgency at Primary Care Unit, Chiangrai Prachanokroh Hospital
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Hypertensive urgency is a condition characterized by critically elevated blood pressure without evidence of acute hypertension-mediated target organ damage. However, failure to achieve blood pressure control may increase the risk of cardiovascular complications, which can lead to disability and mortality. Nevertheless, evidence regarding outcomes in this patient population remains limited.
OBJECTIVE: To determine the prevalence of cardiovascular events within three years after the diagnosis of hypertensive urgency and to identify factors associated with the occurrence of these events.
METHODS: A retrospective cohort study was conducted using medical records from Chiangrai Prachanukroh Hospital between January 1, 2019, and December 31, 2021. The study included 900 patients diagnosed with hypertensive urgency who received care at the Primary Care Unit. The prevalence of cardiovascular events within three years after diagnosis was assessed. Factors associated with the occurrence of cardiovascular events were analyzed using Cox regression analysis. Statistical significance was set at p<0.05.
RESULTS: Among 900 patients, 130 (14.4%) developed cardiovascular complications. The highest incidence occurred during the first year after diagnosis (6.2%), with a decreasing trend over the follow-up period. Factors significantly associated with an increased risk of complications included a history of atrial fibrillation (hazard ratio; HR=6.00), prior stroke (HR=3.06), chronic kidney disease stage ≥4 (HR=2.61), smoking (HR=2.27), and proteinuria ≥1+ (HR=1.60).
CONCLUSIONS AND RECOMMENDATIONS: Among patients with hypertensive urgency, the highest rate of cardiovascular complications occurred during the first year after diagnosis. Therefore, close follow-up during this period, particularly in the first year, is essential. Emphasis should be placed on controlling risk factors and prompt medical evaluation when abnormal symptoms occur.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
World Health Organization. Hypertension [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Aug3]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
Mohammed Nawi A, Mohammad Z, Jetly K, Abd Razak MA, Ramli NS, Wan Ibadullah WAH, et al. The prevalence and risk factors of hypertension among the urban population in Southeast Asian countries: a systematic review and meta-analysis. Int J Hypertens. 2021;2021:6657003.
World Health Organization. Blood pressure/hypertension [Internet]. Geneva: World Health Organization; 2024 [cited 2024 May 4]. Available from: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3155
Ministry of Public Health, Health Data Center [Internet]. Nontaburi: Health Data Center, Ministry of Public Health (Thailand); 2024. Medical and health data repository; 2024 [cited 2024 May 4]. Available from: https://hdc.moph.go.th/cri/public/standard-report-detail/e2a5a66dd74fa1252fcf786674f05f02
Department of Disease Control, Division of Non-Communicable Disease. Situation on NCDs prevention and control in Thailand [Internet]. Bangkok: Aksorn Graphic and Design; 2020 [cited 2024 Jun 11]. Available from: https://ddc.moph.go.th/uploads/publish/1035820201005073556.pdf
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):1269-324.
Thai Hypertension Society. 2024 Thai guidelines on the treatment of hypertension [internet]. Chiangrai: Trik Think Printing House; 2024 [cited 2024 Jun 11] Available from: https://thaihypertension.org/wp-content/uploads/2025/07/Guideline2024.pdf
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104.
Ayele H, Banbeta A, Negash A. Cardiovascular disease risk factors in hypertensive patients: a case study of Jimma University Medical Center. Health Serv Res Manag Epidemiol. 2022;9:1-7.
Vasan RS, Song RJ, Xanthakis V, Beiser A, DeCarli C, Mitchell GF, et al. Hypertension-mediated organ damage: prevalence, correlates, and prognosis in the community. Hypertension. 2022;79(3):505-15.
Lopez EO, Ballard BD, Jan A. Cardiovascular disease. [Updated 2023 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023[cited 2024 May 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535419/
Bosco E, Hsueh L, McConeghy KW, Gravenstein S, Saade E. Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review. BMC Med Res Methodol. 2021;21(1):241.
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-69.
Bozkurt B, Coats AJ, Tsutsui H, Abdelhamid M, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the heart failure society of America, heart failure association of the European Society of Cardiology, Japanese heart failure society and writing committee of the universal definition of heart failure. J Card Fail. 2021;27(4):387-413.
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89.
American Association of Neurological Surgeons [Internet]. Rolling Meadows (IL): American Association of Neurological Surgeons; 2024. Cerebrovascular Disease; 2024 [cited 2026 Feb 25].
Available from: https://www.aans.org/patients/conditions-treatments/cerebrovascular-disease/
Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation 2023;149:e1–156.
Vlcek M, Bur A, Woisetschläger C, Herkner H, Laggner AN, Hirschl MM. Association between hypertensive urgencies and subsequent cardiovascular events in patients with hypertension. J Hypertens. 2008;26(4):657-62.
Fragoulis C, Polyzos D, Mavroudis A, Tsioufis PA, Kasiakogias A, Leontsinis I, et al. One-year outcomes following a hypertensive urgency or emergency. Eur J Intern Med. 2024;120:107-13.
Wu CY, Hu HY, Chou YJ, Huang N, Chou YC, Li CP. High blood pressure and all-cause and cardiovascular disease mortalities in community-dwelling older adults. Medicine (Baltimore). 2015;94(47):e2160.
Paini A, Tarozzi L, Bertacchini F, Aggiusti C, Rosei CA, De Ciuceis C, et al. Cardiovascular prognosis in patients admitted to an emergency department with hypertensive emergencies and urgencies. J Hypertens. 2021;39(12):2514-20.
Mancusi C, Losi MA, Albano G, De Stefano G, Morisco C, Barbato E, et al. Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting: the campania salute network. Am J Hypertens. 2020;33(5):414-21.
Shin JH, Kim BS, Lyu M, Kim HJ, Lee JH, Park JK, et al. Clinical characteristics and predictors of all-cause mortality in patients with hypertensive urgency at an emergency department. J Clin Med. 2021;10(19):4314.
Gawałko M, Linz D. Atrial fibrillation detection and management in hypertension. Hypertension. 2023;80(3):523-33.
