Clinical practices, complications, and mortality in neurological patients with acute severe hypertension

The Studying the Treatment of Acute hyperTension registry

Stephan A. Mayer, Pedro Kurtz, Allison Wyman, Gene Y. Sung, Alan S. Multz, Joseph Varon, Christopher B. Granger, Kurt Kleinschmidt, Marc Lapointe, W. Frank Peacock, Jason N. Katz, Joel M. Gore, Brian Oneil, Frederick A. Anderson

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: To determine the demographic and clinical features, hospital complications, and predictors of 90-day mortality in neurologic patients with acute severe hypertension. Design: Studying the Treatment of Acute hyperTension (STAT) was a multicenter (n = 25) observational registry of adult critical care patients with severe hypertension treated with intravenous therapy. Setting: Emergency department or intensive care unit. Patients: A qualifying blood pressure measurement >180 mm Hg systolic or >110 mm Hg diastolic (>140/90 mm Hg for subarachnoid hemorrhage) was required for inclusion in the STAT registry. Patients with a primary neurologic admission diagnosis were included in the present analysis. Interventions: All patients were treated with at least one parenteral (bolus or continuous infusion) antihypertensive agent. Measurements and Main Results: Of 1,566 patients included in the STAT registry, 432 (28%) had a primary neurologic diagnosis. The most common diagnoses were subarachnoid hemorrhage (38%), intracerebral hemorrhage (31%), and acute ischemic stroke (18%). The most common initial drug was labetalol (48%), followed by nicardipine (15%), hydralazine (15%), and sodium nitroprusside (13%). Mortality at 90 days was substantially higher in neurologic than in non-neurologic patients (24% vs. 6%, p < .0001). Median initial blood pressure was 183/95 mm Hg and did not differ between survivors and nonsurvivors. In a multivariable analysis, neurologic patients who died experienced lower minimal blood pressure values (median 103/45 vs. 118/55 mm Hg, p < .0001) and were less likely to experience recurrent hypertension requiring intravenous treatment (29% vs. 51%, p = .0001) than those who survived. Mortality was also associated with an increased frequency of neurologic deterioration (32% vs. 10%, p < .0001). Conclusion: Neurologic emergencies account for approximately 30% of hospitalized patients with severe acute hypertension, and the majority of those who die. Mortality in hypertensive neurologic patients is associated with lower minimum blood pressure values, less rebound hypertension, and a higher frequency of neurologic deterioration. Excessive blood pressure reduction may contribute to poor outcome after severe brain injury.

Original languageEnglish (US)
Pages (from-to)2330-2336
Number of pages7
JournalCritical Care Medicine
Volume39
Issue number10
DOIs
StatePublished - Oct 2011

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Registries
Nervous System
Hypertension
Mortality
Blood Pressure
Therapeutics
Subarachnoid Hemorrhage
Labetalol
Nicardipine
Hydralazine
Cerebral Hemorrhage
Nitroprusside
Emergency Medical Services
Critical Care
Brain Injuries
Antihypertensive Agents
Intensive Care Units
Survivors
Hospital Emergency Service
Emergencies

Keywords

  • hypertension
  • stroke
  • vasoactive agents

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Clinical practices, complications, and mortality in neurological patients with acute severe hypertension : The Studying the Treatment of Acute hyperTension registry. / Mayer, Stephan A.; Kurtz, Pedro; Wyman, Allison; Sung, Gene Y.; Multz, Alan S.; Varon, Joseph; Granger, Christopher B.; Kleinschmidt, Kurt; Lapointe, Marc; Peacock, W. Frank; Katz, Jason N.; Gore, Joel M.; Oneil, Brian; Anderson, Frederick A.

In: Critical Care Medicine, Vol. 39, No. 10, 10.2011, p. 2330-2336.

Research output: Contribution to journalArticle

Mayer, SA, Kurtz, P, Wyman, A, Sung, GY, Multz, AS, Varon, J, Granger, CB, Kleinschmidt, K, Lapointe, M, Peacock, WF, Katz, JN, Gore, JM, Oneil, B & Anderson, FA 2011, 'Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: The Studying the Treatment of Acute hyperTension registry', Critical Care Medicine, vol. 39, no. 10, pp. 2330-2336. https://doi.org/10.1097/CCM.0b013e3182227238
Mayer, Stephan A. ; Kurtz, Pedro ; Wyman, Allison ; Sung, Gene Y. ; Multz, Alan S. ; Varon, Joseph ; Granger, Christopher B. ; Kleinschmidt, Kurt ; Lapointe, Marc ; Peacock, W. Frank ; Katz, Jason N. ; Gore, Joel M. ; Oneil, Brian ; Anderson, Frederick A. / Clinical practices, complications, and mortality in neurological patients with acute severe hypertension : The Studying the Treatment of Acute hyperTension registry. In: Critical Care Medicine. 2011 ; Vol. 39, No. 10. pp. 2330-2336.
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AU - Wyman, Allison

AU - Sung, Gene Y.

AU - Multz, Alan S.

AU - Varon, Joseph

AU - Granger, Christopher B.

AU - Kleinschmidt, Kurt

AU - Lapointe, Marc

AU - Peacock, W. Frank

AU - Katz, Jason N.

AU - Gore, Joel M.

AU - Oneil, Brian

AU - Anderson, Frederick A.

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N2 - Objective: To determine the demographic and clinical features, hospital complications, and predictors of 90-day mortality in neurologic patients with acute severe hypertension. Design: Studying the Treatment of Acute hyperTension (STAT) was a multicenter (n = 25) observational registry of adult critical care patients with severe hypertension treated with intravenous therapy. Setting: Emergency department or intensive care unit. Patients: A qualifying blood pressure measurement >180 mm Hg systolic or >110 mm Hg diastolic (>140/90 mm Hg for subarachnoid hemorrhage) was required for inclusion in the STAT registry. Patients with a primary neurologic admission diagnosis were included in the present analysis. Interventions: All patients were treated with at least one parenteral (bolus or continuous infusion) antihypertensive agent. Measurements and Main Results: Of 1,566 patients included in the STAT registry, 432 (28%) had a primary neurologic diagnosis. The most common diagnoses were subarachnoid hemorrhage (38%), intracerebral hemorrhage (31%), and acute ischemic stroke (18%). The most common initial drug was labetalol (48%), followed by nicardipine (15%), hydralazine (15%), and sodium nitroprusside (13%). Mortality at 90 days was substantially higher in neurologic than in non-neurologic patients (24% vs. 6%, p < .0001). Median initial blood pressure was 183/95 mm Hg and did not differ between survivors and nonsurvivors. In a multivariable analysis, neurologic patients who died experienced lower minimal blood pressure values (median 103/45 vs. 118/55 mm Hg, p < .0001) and were less likely to experience recurrent hypertension requiring intravenous treatment (29% vs. 51%, p = .0001) than those who survived. Mortality was also associated with an increased frequency of neurologic deterioration (32% vs. 10%, p < .0001). Conclusion: Neurologic emergencies account for approximately 30% of hospitalized patients with severe acute hypertension, and the majority of those who die. Mortality in hypertensive neurologic patients is associated with lower minimum blood pressure values, less rebound hypertension, and a higher frequency of neurologic deterioration. Excessive blood pressure reduction may contribute to poor outcome after severe brain injury.

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