Research Article Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi Aysha Almas, 1 Ayaz Ghouse, 2 Ahmed Raza Iftikhar, 2 and Munawwar Khursheed 3 1 Department of Medicine, Stadium Road, Aga Khan University, P.O. Box 3500, Karachi 74800, Pakistan 2 Aga Khan University Medical College (AKUMC), Karachi 74800, Pakistan 3 Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan Correspondence should be addressed to Aysha Almas; aysha.almas@aku.edu Received 19 May 2014; Revised 25 July 2014; Accepted 25 July 2014; Published 18 August 2014 Academic Editor: Patrizia Ferroni Copyright © 2014 Aysha Almas et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. Tis was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. Te prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. Te mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. Te maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. Te prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup. 1. Background Hypertension is a common chronic medical condition afect- ing people in Pakistan and the rest of the world [1]. It is an important modifable risk factor for cardiovascular morbidity and mortality, particularly for stroke (accounting for 51% of all stroke deaths worldwide), ischemic heart disease (45% of all deaths), chronic kidney disease, congestive heart failure, aortic aneurysm, and peripheral arterial disease [2]. Prevalence of hypertension (systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg, or on antihyper- tensive medications) in Pakistan has increased from 17% in 1980 to 35% in 2008 in adults aged 18 years and older [3]. Te increasing prevalence of hypertension together with a defcient control makes this one of the frequent conditions that require urgent medical attention [4]. Te prevalence of uncontrolled hypertension varies around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women) [5]. Recent population based data for control rates of hypertension from Pakistan are not available. However, the control of hypertension was 23% from a community based data in urban population from Karachi, Pakistan [6]. Uncontrolled hypertension can progress to hypertensive crisis defned as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg [7]. Hypertensive crisis can be fur- ther classifed as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. “Hypertensive urgency” refers to severe hypertension without evidence of new or worsening end-organ injury while “Hypertensive emergency” refers to a severe hypertension that is associated with new or progressive end-organ damage [8]. Hypertensive crises (76% urgencies, 24% emergencies) represented more than one-fourth of all medical urgen- cies/emergencies. Hypertensive urgencies frequently present Hindawi Publishing Corporation International Journal of Chronic Diseases Volume 2014, Article ID 413071, 7 pages http://dx.doi.org/10.1155/2014/413071