Emergency department patients with acute severe hypertension: A comparison of those admitted versus discharged in studying the treatment of acute hypertension registry

Kurt Kleinschmidt, Phillip Levy, Allison Wyman, Joseph F. Dasta, Stephan A. Mayer, Alpesh Amin, Charles Pollack, Andrew F. Shorr, James B. Froehlich, Alan S. Multz, William Frank Peacock

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

OBJECTIVES:: To compare the characteristics, treatments, and outcomes for emergency department (ED) patients with severe hypertension by disposition (admitted versus discharged home). METHODS:: Studying the Treatment of Acute hyperTension (STAT) is a multicenter registry of 1566 patients with blood pressure ≥180/110 mm Hg who were treated with intravenous antihypertensive medications in an ED or intensive care unit. Presenting and in-hospital variables, and postdischarge outcomes for the 1053 patients in the ED subset were compared by disposition. RESULTS:: In the multivariable analysis, ED patients were less likely to be discharged if >75 years of age (odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.1-0.9) or if they had shortness of breath (OR = 0.4, 95% CI = 0.2-0.8) or alteration of mental status (OR = 0.1, 95% CI = 0.02-0.9) on arrival. Nondialysis patients with an admission creatinine concentration >1.5 mg/dL were 80% less likely to be discharged than those ≤1.5 mg/dL (OR = 0.2, 95% CI = 0.08-0.5). In the bivariate analysis, patients with a decrease in systolic blood pressure of <10% 2 hours after medication administration were more likely to be admitted than those discharged (57% vs. 44%; P = 0.041). Disposition did not correlate with 90-day or 6-month mortality or 30-day readmission. However, admitted patients had a higher 90-day readmission rate (38% vs. 24%; P = 0.038). CONCLUSIONS:: ED patients with severe hypertension were more likely to be admitted to the hospital if they were >75 years of age, presented with shortness of breath or altered mental status, or had a creatinine >1.5 mg/dL and were not on hemodialysis.

Original languageEnglish (US)
Pages (from-to)66-72
Number of pages7
JournalCritical Pathways in Cardiology
Volume13
Issue number2
DOIs
Publication statusPublished - 2014

    Fingerprint

Keywords

  • Disposition
  • Elevated blood pressure
  • Hypertension
  • Hypertensive emergency
  • STAT registry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this