What is the prevalence of each crisis?

From the Guidelines

The prevalence of hypertensive crises varies, with approximately one in every two to three patients presenting with a hypertensive emergency, and the most common types being heart failure, stroke, and myocardial infarction. According to the most recent study 1, the prevalence of hypertensive emergencies is significant, with one in every 200 patients presenting at the emergency department (ED) with a suspected hypertensive emergency. The study found that:

• Heart failure, stroke, and myocardial infarction represented the largest proportion of all hypertensive emergencies
• Intracranial haemorrhage and aortic dissection were also common
• The incidence of hypertensive emergencies with advanced retinopathy was relatively low Another study 1 discussed the prevalence of heart failure, which is a common type of hypertensive crisis, and found that:
• Approximately 5 million individuals in the United States are living with heart failure (2.3% of the general population)
• An additional 550,000 new cases are diagnosed each year
• Heart failure accounts for more than 1 million hospital admissions annually and is the leading discharge diagnosis for all patients older than 65 years. However, it is essential to note that the prevalence of hypertensive crises may vary depending on the population and the specific type of crisis. The most recent study 1 provides the most up-to-date information on the prevalence of hypertensive emergencies, and its findings should be prioritized in clinical practice. In terms of morbidity, mortality, and quality of life, it is crucial to recognize the significance of hypertensive crises and to provide prompt and effective treatment to reduce the risk of adverse outcomes. Therefore, healthcare providers should be aware of the prevalence and types of hypertensive crises and prioritize early recognition and treatment to improve patient outcomes.

From the FDA Drug Label

Table 7: Overview of Efficacy Results in TNT

Endpoint	Atorvastatin 10 mg (N=5,006)	Atorvastatin 80 mg (N=4,995)	HR a (95%CI)
PRIMARY ENDPOINT
First major cardiovascular	548(10.9)	434(8.7)	0.78 (0.69,0.89)
endpoint
Components of the Primary
Endpoint
CHD death	127(2.5)	101(2.0)	0.80 (0.61,1. 03)
Non-fatal, non-procedure	308(6.2)	243(4.9)	0.78 (0.66,0.93)
related MI
Resuscitated cardiac arrest	26(0.5)	25(0.5)	0.96 (0.56,1.67)
Stroke (fatal and non-fatal)	155(3.1)	117(2.3)	0.75 (0.59,0.96)

The prevalence of each crisis is as follows:

• CHD death: 2.5% in the atorvastatin 10 mg group and 2.0% in the atorvastatin 80 mg group.
• Non-fatal, non-procedure related MI: 6.2% in the atorvastatin 10 mg group and 4.9% in the atorvastatin 80 mg group.
• Resuscitated cardiac arrest: 0.5% in both the atorvastatin 10 mg and 80 mg groups.
• Stroke (fatal and non-fatal): 3.1% in the atorvastatin 10 mg group and 2.3% in the atorvastatin 80 mg group. 2

From the Research

Prevalence of Cardiovascular Crises

The prevalence of cardiovascular crises, including myocardial infarction, stroke, and heart failure, varies among different populations and is influenced by factors such as diabetes, high blood pressure, and high LDL cholesterol.

• According to a study published in Diabetes Care 3, the event rates per 100 person-years for adults with diabetes and cardiovascular disease (CVD) versus those without CVD were:
  • 6.0 vs. 1.7 for myocardial infarction (MI) and acute coronary syndrome (ACS)
  • 5.3 vs. 1.5 for stroke
  • 8.4 vs. 1.2 for heart failure (HF)
  • 18.1 vs. 4.0 for all cardiovascular events
  • 23.5 vs. 5.0 for all-cause mortality
• A study published in Circulation: Cardiovascular Quality and Outcomes 4 found that the 5-year rate of death or acute coronary syndrome was significantly lower in patients receiving intensive-dose statins compared to those receiving moderate-dose statins.
• Another study published in The Journal of Clinical Endocrinology and Metabolism 5 found that the average change in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for a composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, hospitalization for acute coronary syndromes, or coronary revascularization.
• A retrospective population-based cohort study published in Advances in Therapy 6 found that first and total major cardiovascular event (MACE) rates were numerically 1.5-3 times higher in subgroups with additional risk factors, such as diabetes mellitus with target organ damage, chronic kidney disease stages 3-4, index event within 2 years after prior MI or IS, and polyvascular disease.
• A study published in The Lancet 7 found that elevated LDL cholesterol was associated with an increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years, with the highest absolute risk and lowest estimated number needed to treat (NNT) in 5 years to prevent one event in this age group.

Risk Factors and Event Rates

The studies suggest that various risk factors, including diabetes, high blood pressure, high LDL cholesterol, and smoking, contribute to the prevalence of cardiovascular crises.

• The event rates per 100 person-years for adults with diabetes and CVD versus those without CVD were significantly higher for all cardiovascular events and all-cause mortality 3.
• The 5-year rate of death or acute coronary syndrome was significantly lower in patients receiving intensive-dose statins compared to those receiving moderate-dose statins 4.
• The average change in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for a composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, hospitalization for acute coronary syndromes, or coronary revascularization 5.
• First and total MACE rates were numerically 1.5-3 times higher in subgroups with additional risk factors, such as diabetes mellitus with target organ damage, chronic kidney disease stages 3-4, index event within 2 years after prior MI or IS, and polyvascular disease 6.
• Elevated LDL cholesterol was associated with an increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years, with the highest absolute risk and lowest estimated NNT in 5 years to prevent one event in this age group 7.