Hypertensive Crisis: Moving Towards More Holistic Patient Care

  • Karthik Subbu Eastern Virginia Medical School
  • Michael P. Lee Eastern Virginia Medical School


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. 

Author Biographies

Karthik Subbu, Eastern Virginia Medical School

Karthik Subbu is a member of the Eastern Virginia Medical School (EVMS) Class of 2018. He graduated with honors from the University of Virginia with a B.A. in Psychology. In medical school, he participates actively in the EVMS student-run free clinic, HOPES, having served as a co-lead of the Monitoring, Evaluation, and Quality team from 2015-2016 and as the current Director of Innovations from 2016-2017. After obtaining his M.D., he plans to pursue a career in internal medicine.

Michael P. Lee, Eastern Virginia Medical School
Michael Lee is a student at Eastern Virginia Medical School (EVMS) Class of 2019. He graduated with a B.S. in Bioengineering from University of California, San Diego. He is active as a tutor within the EVMS peer tutoring program and has taught anatomy, cell biology, and pathology. At EVMS student run free clinic, HOPES, he has served as co-lead of the Shift Manager team from 2016-2017 and has also been a member of the EMR and Monitoring, Evaluation, and Quality teams. He plans on pursuing a career in internal medicine.


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How to Cite
Subbu, K., & Lee, M. (2016). Hypertensive Crisis: Moving Towards More Holistic Patient Care. Free Clinic Research Collective, 2(1). Retrieved from http://www.themspress.org/journal/index.php/freeclinic/article/view/232