Hypertensive Crisis Much More Common in Blacks

Megan Brooks

October 01, 2018

CHICAGO — African-Americans suffer hypertensive crisis at a rate five times higher than the national average, new research suggests.

Frederick A. Waldron

"We studied an inner-city population to find that being black is a risk factor for progressing from hypertension to hypertensive crisis," study author Frederick A. Waldron, MD, Newark Beth Israel Medical Center, Newark, New Jersey, said in a statement.

"Now that we have effective antihypertensive medications available, hypertensive crisis and hypertensive emergency, a rare but further progression of hypertensive crisis in which organ damage occurs, should not exist to this degree among black or other patients," said Waldron.

Waldron presented the study during the American Heart Association (AHA) Joint Hypertension 2018 Scientific Sessions.

He and a colleague reviewed the medical records of 15,631 hypertensive patients seen in their emergency department from 2013 to 2016. Of these, 1784 (11.4%) patients came to the emergency department in hypertensive crisis, which they defined as blood pressure at or above 200/120 mm Hg, and 89% of them were African-American.

More than a quarter of the patients in hypertensive crisis (28%) developed end-organ damage, including stroke, congestive heart failure, kidney failure, or myocardial infarction (MI).

Risk for End Organ Damage With Hypertensive Crisis
Outcome Odds ratio P Value
Acute kidney injury 1.54 .022
Acute/worsening congestive heart failure 4.91 <.0001
Non-ST elevation MI 2.39 <.0001
Ischemic stroke 3.27 <.0001
Hemorrhagic stroke 4.55 <.001

Predictors of end-organ damage were age older than 65, male gender, anemia, chronic kidney disease, and history of stroke and cardiovascular comorbidities (hyperlipidemia, coronary artery disease, congestive heart failure).

This study highlights the "high morbidity" of poorly controlled hypertension, the researchers note in their conference abstract, and the disparity in the prevalence of hypertensive crisis in the African-American population, "which is five times the national average."

The researchers note that the numbers in the study might be an underestimation because of the different definitions of hypertensive crisis. For example, the AHA defines hypertensive crisis as blood pressure at or above 180/120 mm Hg, whereas this study defined it as above 200/120 mm Hg.

Future studies should determine rate of adherence to blood pressure medications and follow patients in hypertensive crisis longer to determine the true incidence of hypertension emergency, they conclude.

Hypertensive Crisis

Reached for comment, AHA spokesperson Richard Becker, MD, University of Cincinnati, said, "We certainly know that hypertension is more common in African-Americans.

"We also know that responses to medications for hypertension are different in African-Americans, and that hypertension and hypertensive crisis is associated with organ damage and death," he said.

"In terms of why we are seeing hypertensive crisis more often in African-Americans, honestly, we don't have the answer. Therefore, it is the perfect opportunity for further investigation," Becker concluded.

The study had no commercial funding. Waldron and Becker have disclosed no relevant financial relationships.

Joint Hypertension 2018 Scientific Sessions (HYP): Poster 297. Presented September 7, 2018.

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