Étude prospective observationnelle au niveau du service d’urgence de l’hôpital mixte de Laghouat

Abstract

Introduction: Hypertension is a major public health issue and a frequent reason for emergency department (ED) visits. Epidemiological data regarding hypertension in emergency settings remain limited in Algeria. Objective: This study aimed to determine the prevalence of hypertension in the emergency department and to describe the sociodemographic, clinical, paraclinical, therapeutic, and outcome characteristics of patients admitted to the Emergency Department of Laghouat Mixed Hospital. Methods: We conducted a prospective, descriptive, cross-sectional, single-center study with an analytical component, including all civilian adult patients (>18 years) admitted to the Emergency Department of Laghouat Mixed Hospital (LMH) with hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg). All patients presenting with hypertension (BP >140/90 mmHg) were included regardless of the reason for consultation, whether they had uncontrolled hypertension (without acute or subacute target-organ damage) or a hypertensive emergency (with acute or subacute target-organ damage). Following descriptive and comparative statistical analyses using the Chi-square test and Mann–Whitney U test (p < 0.05), sociodemographic, clinical, paraclinical, and outcome characteristics were compared between the two groups. Multivariate logistic regression analysis was performed using SPSS software to identify factors independently associated with the occurrence of hypertensive emergencies. Results: Between November 1, 2025, and April 30, 2026, emergency department records identified 154 civilian patients presenting with hypertension among a total of 16,902 consultations. During the same period, 10,579 patients were registered at the emergency admissions office, including 1,649 hospitalized for medical emergencies. Among the 154 hypertension cases, 74 patients (48.05%; 95% CI: 40.30–55.89%; p = 0.63) presented with a hypertensive emergency (BP ≥140/90 mmHg with at least one acute or subacute target-organ injury), whereas 80 patients (51.94%; 95% CI: 44.11–59.70%; p = 0.63) had uncontrolled hypertension (BP ≥140/90 mmHg, symptomatic or asymptomatic, without target-organ damage), including 48 cases (60%; 95% CI: 24.39–38.87%) of severe uncontrolled hypertension (BP ≥180/110 mmHg, symptomatic or asymptomatic, without target-organ damage). A total of 154 patients with hypertension were identified in the emergency department, of whom 55.84% were male. Hypertension was previously known in 62.33% of patients, while 37.66% were unaware of their hypertensive status before admission. Diabetes mellitus was present in 28.57% of patients, and 70.12% were obese. Patients in the hypertensive emergency (HE) group were significantly older than those in the uncontrolled hypertension (UH) group, with median ages of 65.5 years (IQR = 22) and 53 years (IQR = 18), respectively. Clinically, the main conditions associated with hypertensive emergencies were ischemic stroke (36.48%), acute pulmonary edema (25.67%), and acute kidney injury (21.62%). The predominant clinical manifestations in the HE group were dyspnea (24.32%), motor deficits (31.08%), and chest pain (17.56%). In contrast, patients in the uncontrolled hypertension group mainly presented with headaches (48.75%) and dizziness (33.75%). Multivariate analysis identified advanced age as an independent risk factor for hypertensive emergencies (OR = 1.043; 95% CI: 1.015–1.071; p = 0.002). Likewise, discontinuation of antihypertensive treatment was strongly associated with an increased risk, with an odds ratio of 7.178 (95% CI: 1.638–31.460; p = 0.009). Clinical outcomes were favorable in 85.13% of hypertensive emergency cases and in 96.25% of uncontrolled hypertension cases. In-hospital mortality was low, estimated at 1.35%. Conclusion: The prevalence of hypertension in the emergency department of LMH is comparable to that reported in the literature. However, the relatively high proportion of hypertensive emergencies (48.05%) may be explained by recruitment bias. The study also highlights the lack of standardization in local clinical practices, emphasizing the need to strengthen patient therapeutic education and implement structured, harmonized management protocols to improve overall hypertension care. Finally, the most effective strategy for preventing hypertensive emergencies remains optimal blood pressure control.