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Severe acute hypertension among inpatients admitted from the emergency department
Andrew F Shorr1, Marya D Zilberberg, Xiaowu Sun
1Pulmonary and Critical Care Medicine Service, Washington Hospital Center, Washington, DC 20010, USA. andrew.shorr@gmail.com
Background:
Hospitalists often treat patients with severe acute hypertension (AH) presenting to the hospital. Little is known about the epidemiology of this syndrome.
Objective:
To examine the prevalence of severe AH in patients admitted through the emergency department (ED) and its associated outcomes.
Design:
A cohort study using retrospectively collected vital signs and other clinical data.
Patients:
A total of 1,290,804 adults admitted between 2005 and 2007.
Setting:
One hundred fourteen acute-care hospitals.
Measurements:
Severe AH was defined as at least 1 systolic blood pressure (SBP) >180 mmHg. We used multivariable regression to estimate AH-attributable in-hospital mortality, need for mechanical ventilation (MV), and length of stay (LOS).
Results:
Severe AH occurred in 178,131 (13.8%) patients. Disease categories with the highest prevalence were nervous (29.0%), circulatory (16.0%), endocrine (14.7%), and kidney/urinary (13.5%). The overall in-hospital mortality was 3.6%. The relationship between severe AH strata and mortality was graded for nervous system diseases; mortality rates for each 10 mmHg increase in SBP from 180 to >220 mmHg were 6.5%, 8.1%, 9.9%, 12.0%, and 19.7%, respectively (P < 0.0001). The relationship between severe AH strata and need for MV was graded in the most pronounced way in respiratory and circulatory conditions (P < 0.0001). The relationship between severe AH strata and LOS was graded in most disease categories (P < 0.0001).
Conclusions:
Severe AH appears common and its prevalence varies by underlying clinical condition. Severe AH is associated with excess in-hospital mortality for patients with nervous system diseases and, for most disease categories, prolongs hospitalization.
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