MedStar Authors catalog › Details for: Severe acute hypertension among inpatients admitted from the emergency department.
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Severe acute hypertension among inpatients admitted from the emergency department.

by Shorr, Andrew F.
Citation: Journal of Hospital Medicine (Online). 7(3):203-10, 2012 Mar..Journal: Journal of hospital medicine : an official publication of the Society of Hospital Medicine.ISSN: 1553-5592.Full author list: Shorr AF; Zilberberg MD; Sun X; Johannes RS; Gupta V; Tabak YP.UI/PMID: 22038891.Subject(s): Acute Disease | Aged | Aged, 80 and over | *Emergency Service, Hospital | Female | Humans | *Hypertension/ep [Epidemiology] | *Inpatients | Length of Stay | Male | Medical Audit | Middle Aged | Patient Admission | Prevalence | Retrospective Studies | Severity of Illness Index | United States/ep [Epidemiology]Institution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Pulmonary-Critical CareActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, Non-U.S. Gov'tDigital Object Identifier: http://dx.doi.org/10.1002/jhm.969 (Click here) Abbreviated citation: J Hosp Med. 7(3):203-10, 2012 Mar.Local Holdings: Available in print through MWHC library: 2007 only.Abstract: BACKGROUND: Hospitalists often treat patients with severe acute hypertension (AH) presenting to the hospital. Little is known about the epidemiology of this syndrome.Abstract: OBJECTIVE: To examine the prevalence of severe AH in patients admitted through the emergency department (ED) and its associated outcomes.Abstract: DESIGN: A cohort study using retrospectively collected vital signs and other clinical data.Abstract: PATIENTS: A total of 1,290,804 adults admitted between 2005 and 2007.Abstract: SETTING: One hundred fourteen acute-care hospitals.Abstract: MEASUREMENTS: Severe AH was defined as at least 1 systolic blood pressure (SBP) >180 mmHg. We used multivariable regression to estimate AH-attributable in-hospital mortality, need for mechanical ventilation (MV), and length of stay (LOS).Abstract: RESULTS: Severe AH occurred in 178,131 (13.8%) patients. Disease categories with the highest prevalence were nervous (29.0%), circulatory (16.0%), endocrine (14.7%), and kidney/urinary (13.5%). The overall in-hospital mortality was 3.6%. The relationship between severe AH strata and mortality was graded for nervous system diseases; mortality rates for each 10 mmHg increase in SBP from 180 to >220 mmHg were 6.5%, 8.1%, 9.9%, 12.0%, and 19.7%, respectively (P < 0.0001). The relationship between severe AH strata and need for MV was graded in the most pronounced way in respiratory and circulatory conditions (P < 0.0001). The relationship between severe AH strata and LOS was graded in most disease categories (P < 0.0001).Abstract: CONCLUSIONS: Severe AH appears common and its prevalence varies by underlying clinical condition. Severe AH is associated with excess in-hospital mortality for patients with nervous system diseases and, for most disease categories, prolongs hospitalization. Copyright 2011 Society of Hospital Medicine.

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