Hypertensive Crisis: Moving Towards More Holistic Patient Care

Karthik Subbu, Michael P. Lee


Introduction: Hypertension is well-known to be a “silent killer” and plays a significant role in the onset and progression of many diseases including heart failure, diabetes, cerebrovascular disease, and renal failure. Hypertensive crisis, in particular, is defined as a blood pressure greater than 180/120 and can lead to extensive end-organ damage7. In this study, our aim was to determine how extensive the issue of uncontrolled hypertension is for our patients being seen at specialty clinics.


Methods: A retrospective chart review was conducted on specialty clinic visits at HOPES between August 1, 2015 and July 31, 2016. All patients with (a) two or more instances of uncontrolled hypertension (as defined by the JNC8 guidelines9) or (b) hypertensive urgency were recorded. We then reviewed the charts of these patients to determine whether they were being followed at HOPES Primary Care clinic for their hypertension.


Results: Out of 153 patients seen at HOPES specialty clinics during the above time period, seven patients were found to have two or more instances of uncontrolled hypertension and 18 additional patients were found to have instances of hypertensive urgency. Of these 25 patients, six (24.0%) were not concurrently followed at Primary Care clinic.


Conclusion: The results of our chart review demonstrated that nearly one in four patients at HOPES with uncontrolled hypertension or an instance of hypertensive urgency were not concurrently being followed at HOPES Primary Care clinic for their hypertension. By assessing how extensive the issue of untreated uncontrolled hypertension is at our clinic, our staff can better allocate resources to our Primary Care clinic in order to schedule appointments for our hypertensive patients so that they may be cared for in a holistic manner. 

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Levy D, Larson M, Vasan R, et al. The progression from hypertension to congestive heart failure. JAMA 1996; 275(20):1557-1562.

Sower JR, Levy I, Zemel MB. Hypertension and diabetes. The Medical Clinics of North America 1998; 72(6):1399-1414.

Jones W, Williams L, Bruno A, Biller J, et al. Hypertension and cerebrovascular disease. Seminars in Cerebrovascular Diseases and Stroke 2003; 3(3):144-1

Walker WG. Hypertension-related renal injury: a major contributor to end-stage renal disease. Am J Kidney Dis 1993; 22(1):164-173.

Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303(20):2043.

Kessler C, Joudeh Y. Evaluation and treatment of severe asymptomatic hypertension. Am Fam Physician 2010; 81(4):470-476.

Hopkins C. (2015, Aug 18). Hypertensive emergencies. Medscape. Accessed 11/12/2016 from http://emedicine.medscape.com/article/1952052-overview

Gillespie C, Hurvitz K. Prevalence of hypertension and controlled hypertension - United States, 2007-2010. Morbidity and Mortality Weekly Report 2013; 62(3):144-148

James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014; 311: 507-520.

Woolhandler S, Himmelstein D. Reverse targeting of preventive care due to lack of health insurance. JAMA 1988; 259(19):2872-2874.

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