Hypertensive Emergencies in the Department of Cardiology at the Teaching University Hospital of Brazzaville (Republic of the Congo): Preliminary Study

Background: Hypertensive emergencies are still a common mode of finding hypertension. Objective: to determine the epidemiological, clinical and paraclinical characteristics of the hypertensive emergency, and to evaluate the factors associated with poor blood pressure control. Patients and method: cross-sectional and analytical study, conducted from July 2010 to June 2014 (4 years), in the cardiology department of the Brazzaville University Hospital. Included, patients admitted were those systolic blood pressure (BP) ≥ 180 mm Hg, and diastolic BP ≥ 110 mm Hg, with target organ involvement. A minimum biological assessment, an ECG, a chest X-ray, a brain CT-scan and a cardiac ultrasound were required. Results: Fifty patients were included, including 31 women (62%). The mean age was 53.8 ± 13.7 years old, age < 60 years (n = 34; 68%), low income population (n = 23; 46%). Hypertension was often known (n = 49; 98%), and poor compliance (n = 33; 67.4%). Associated risk factors were: obesity (n = 13), and diabetes (n = 7). The average consultation time was 4.1 ± 3.7 days. The reasons for hospitalization were: dyspnea (n = 24; 48%), neuro-sensory signs (n = 24; 48%), and functional limb impotence (n = 15; 30%). The major laboratory abnormalities were hyperuricemia (n = 16; 32%) and hyperglycemia (n = 16). Left ventricular hypertrophy was noted at the ECG (n = 29; 58%). Cardiac ultrasound showed a LVEF < 40% (n = 8). The main hypertensive emergencies were: heart failure (n = 23; 46%), stroke (n = 23; 46%), severe renal failure (n = 10;20%), and malignant hypertension (n = 23; 46%). The average hospital stay was 11.4 ± 5.5 days, and 1 death was recorded. BP was uncontrolled in 38 cases (76%). Factors associated with uncontrolled blood pressure were: female sex (OR 3; 95% CI 0.8 - 11.5) and low-income patient (OR 1.26; 95% CI 0.34 - 4.68). Conclusion: organs affected during hypertensive emergencies are most often the heart, the brain and the kidney in our context. Early management of hypertension will reduce these complications.