Hypertensive Crisis in an Era of Escalating Health Care Changes

Theresa P. Yeo; Sherry A. Burrell


Journal for Nurse Practitioners. 2010;6(5):338-346. 

In This Article

Epidemiology of Hypertensive Crisis

It is estimated that between 1% and 5% of persons with HTN will develop a hypertensive crisis at some point in their lifetime.[12,13,17] The prevalence of hypertensive crisis mirrors that of essential HTN in the United States, in which the incidence is higher in older adults, blacks and African Americans, and men.[18,19] The majority of patients presenting in hypertensive crisis have a prior history of HTN and have been prescribed antihypertensive medications at some point.[20] Sudden escalation of essential, chronic HTN (also called accelerated HTN) is a common precipitant of hypertensive crisis, though drug interactions and/or withdrawal of treatment are also frequently factors.

Uncontrolled BP is a major risk factor for hypertensive crisis with an accompanying cardiovascular event and TOD. Predictors of uncontrolled BP are advancing age, persistent stage I HTN, use of fewer antihypertensive agents, uncontrolled diabetes, hyperlipidemia, HF, and nephropathy.[4] A 1996 study on the prevalence of hypertensive crisis found that it accounts for 25% of all emergency department visits.[17] A quarter of these patients experienced cerebral infarction, 37% had pulmonary edema or heart failure, 12% had acute coronary syndromes, 4.5% had intracerebral or subarachnoid hemorrhage, 13% had unsuspected cocaine use,[21] 4.5% had eclampsia, and 2% had an acute aortic dissection.[22]