Perfil clínico-epidemiológico e os fatores associados ao desfecho de óbito entre os pacientes com emergências hipertensivas no Hospital Universitário de Lagarto/SE

Abstract

Introduction: Hypertensive emergencies are characterized by a marked increase in blood pressure (SBP ≥ 180 mmHg and/or DBP ≥ 120 mmHg), associated with acute target organ damage and risk of death. In this scenario, clinical and epidemiological variables may be potential predictors of in-hospital mortality. Objective: To analyze the clinical-epidemiological profile of patients treated for hypertensive emergencies between 2023 and 2024 at the Lagarto University Hospital (HUL) and the factors associated with death. Methods: This is an observational and analytical study, of the retrospective cohort type, whose final sample included 356 patients. In this sense, univariate and multivariate analyses were performed using Cox regression, in addition to survival comparison with Kaplan-Meier curves and the Log-Rank test. Results: A higher prevalence was observed in the elderly (70.2%), males (55.3%), brown race (46.9%), and patients with comorbidities and/or previous risk factors (85.7%), a profile most represented by hypertension (78.1%). The main clinical presentations were ischemic stroke (40.2%) and acute pulmonary edema (24.4%). The mortality rate was 36.2% (95% CI: 31.241.5). The development of complications was strongly associated with mortality in hypertensive emergencies (aHR = 8.01; 95% CI: 3.93–16.28; p < 0.001). The need for mechanical ventilation was also associated with lower survival (aHR = 1.67; 95% CI: 1.282.75; p < 0.05), while the longer time required for the use of this support was not statistically significant even after sensitivity adjustment and multivariate analysis (aHR = 0.94; 95% CI: 0.75–1.63; p > 0.05). Conclusion: The mortality rate was high, possibly due to the influence of selection bias caused by transfers. The development of complications related to hypertensive emergencies was the main predictor of in-hospital death. The need for invasive mechanical ventilation is an important indicator of severity, while the time on mechanical ventilation was not associated, probably influenced by survival bias caused by early deaths.