Clinical characteristics of Black patients with hypertensive urgency

Hypertensive urgency is defined as a severely elevated systolic blood pressure (SBP) of ≥ 180 mmHg and/or diastolic blood pressure (DBP) of ≥ 120 mmHg, in the absence of end organ damage. It is known that there are racial differences in prevalence and severity of hypertension but there is a dearth of studies looking at hypertensive urgency in Black populations living in Europe.

We sought to define the clinical characteristics of Black patients presenting with hypertensive urgency, in order to better define the risks and complications this growing population of patients faces.

This was a single-centre retrospective cohort study of 63 consecutive Black and Afro-Caribbean patients attending a South London district general hospital outpatient hypertension clinic from April 2014 to June 2016. All patients had initially presented with hypertensive urgency to their GP, the Emergency Department, or the hospital’s medical take.

The cohort had a mean age of 52.7 years and an even gender balance. Thirty-four patients had a pre-existing diagnosis of hypertension, with a 9-year median time since diagnosis. This was the first presentation of hypertension for the remaining 46%. Other comorbidities found were diabetes mellitus (10%), ischaemic heart disease (5%), hyperlipidaemia (5%), and cerebrovascular disease (2%). Patients who drank alcohol regularly were found to have significantly higher blood pressures than those who did not. Most patients presented with typical symptoms of uncontrolled hypertension, with headache (25%) and chest pain (16%) being most common. Features of end organ damage were also common, with 32 patients having hypertensive retinopathy, 16 patients having proteinuria and 14 patients found to have left ventricular hypertrophy on echocardiography.

The large proportion of newly diagnosed hypertensive patients presenting with end organ signs of prolonged uncontrolled hypertension suggests that there are significant numbers of undiagnosed Black patients in the community, suggesting that we should more actively conduct test for hypertension and its complications when we encounter these patients, who constitute a growing part of the populations in Europe.