TY - JOUR
T1 - Emergency department patients with acute severe hypertension
T2 - A comparison of those admitted versus discharged in studying the treatment of acute hypertension registry
AU - Kleinschmidt, Kurt
AU - Levy, Phillip
AU - Wyman, Allison
AU - Dasta, Joseph F.
AU - Mayer, Stephan A.
AU - Amin, Alpesh
AU - Pollack, Charles
AU - Shorr, Andrew F.
AU - Froehlich, James B.
AU - Multz, Alan S.
AU - Peacock, William Frank
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2014/6
Y1 - 2014/6
N2 - 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.
AB - 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.
KW - Disposition
KW - Elevated blood pressure
KW - Hypertension
KW - Hypertensive emergency
KW - STAT registry
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U2 - 10.1097/HPC.0000000000000014
DO - 10.1097/HPC.0000000000000014
M3 - Article
C2 - 24827883
AN - SCOPUS:84901460360
SN - 1535-282X
VL - 13
SP - 66
EP - 72
JO - Critical pathways in cardiology
JF - Critical pathways in cardiology
IS - 2
ER -