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Risk of Major Adverse Cardiovascular Events After Emergency Department Visits for Hypertensive Urgency
Ava L Liberman1, Junaid Razzak2, Richard I Lappin2
1Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.).
Hypertension (Dallas, Tex. : 1979)
|April 25, 2024
Summary
Emergency department visits for hypertensive urgency significantly increase short-term major adverse cardiovascular events (MACE) risk. This risk is highest in the week following the visit, decreasing over time.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Emergency Medicine
Background:
- Chronic hypertension is a known long-term risk factor for major adverse cardiovascular events (MACE).
- Short-term MACE risk following hypertensive urgency is not well understood.
- Hypertensive urgency is defined as acute severe hypertension without target-organ damage.
Purpose of the Study:
- To evaluate the short-term risk of MACE after an emergency department (ED) visit for hypertensive urgency.
- To assess MACE risk in patients discharged home after ED visits for hypertensive urgency.
Main Methods:
- Case-crossover study utilizing deidentified administrative claims data.
- Case periods were 1-week intervals up to 12 weeks before MACE hospitalization.
- Compared ED visits for hypertensive urgency during case periods versus control periods 1 year prior.
- Utilized validated ICD-10-CM codes for ascertainment and McNemar test for risk ratios.
Main Results:
- Among patients with MACE, 4,644 (0.2%) had a preceding ED visit for hypertensive urgency.
- ED visits for hypertensive urgency were significantly more common in the week before MACE (Risk Ratio: 3.5).
- The association decreased with time, becoming non-significant by 11 weeks prior to MACE.
Conclusions:
- Emergency department visits for hypertensive urgency are linked to a significantly elevated short-term MACE risk.
- The highest risk is observed in the immediate period following the ED visit.
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