Effects of chronic hypertension on burn fluid resuscitation and outcomes

Chronic hypertension is highly prevalent and may alter vascular autoregulation and perfusion thresholds in critically ill patients. However, its impact on fluid resuscitation requirements in major burn injury remains poorly defined. This study aimed to evaluate the effects of preexisting chronic hypertension on resuscitation parameters and clinical outcomes in adult burn patients.

We conducted a retrospective cohort study of adult patients with ≥20% total body surface area burns admitted between July 2011 and July 2021. Patients with both a documented diagnosis of hypertension and home antihypertensive medication use were classified as hypertensive. Outcomes included crystalloid resuscitation volumes at 24 and 48 hours. Secondary outcomes included urine output, mean arterial pressure, length of stay, and mortality.

A total of 190 burn patients were split into two groups, 30 patients with chronic hypertension and 160 control patients. Baseline characteristics were largely similar between groups, though hypertensive patients had significantly less full-thickness burn. In-hospital mortality was numerically higher in the hypertensive group, but did not reach statistical significance. Early resuscitation volumes were comparable between groups. Mean arterial pressure and urine output were similar between groups.

Chronic hypertension was not associated with significantly different in-hospital mortality, early crystalloid requirements, urine output, or mean arterial pressure trends. These findings suggest that standard burn resuscitation targets may be applicable in patients with chronic hypertension.