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Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine:
doi: 10.1097/HPC.0000000000000014
Original Articles

Emergency Department Patients With Acute Severe Hypertension: A Comparison of Those Admitted Versus Discharged in Studying the Treatment of Acute Hypertension Registry

Kleinschmidt, Kurt MD; Levy, Phillip MD, MPH; Wyman, Allison MS§; Dasta, Joseph F. MSc; Mayer, Stephan A. MD; Amin, Alpesh MD**; Pollack, Charles MD, MA††; Shorr, Andrew F. MD‡‡; Froehlich, James B. MD, MPH§§; Multz, Alan S. MD¶¶; Peacock, William Frank MD‖‖

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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.

Copyright © 2014 by Lippincott Williams & Wilkins

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