Hypertensive Crisis: Moving Towards More Holistic Patient Care

Abstract

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.