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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 Jr MD, MA††; Shorr, Andrew F. MD‡‡; Froehlich, James B. MD, MPH§§; Multz, Alan S. MD¶¶; Peacock, William Frank MD‖‖; for the STAT Investigators

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine: June 2014 - Volume 13 - Issue 2 - p 66–72
doi: 10.1097/HPC.0000000000000014
Original Articles

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.

From the *Society of Chest Pain Centers, Columbus, OH; UT Southwestern Medical Center, Dallas, TX; Wayne State University School of Medicine and Cardiovascular Research Institute, Detroit, MI; §Center for Outcomes Research, UMASS Medical School, Worcester, MA; University of Texas College of Pharmacy, Dallas, TX; Columbia University Medical Center, New York, NY; **University of California Irvine Medical Center, Irvine, CA; ††Pennsylvania Hospital, Philadelphia, PA; ‡‡Washington Hospital Center, Washington, DC; §§University of Michigan Medical School, Ann Arbor, MI; ¶¶Albert Einstein College of Medicine, Bronx, New York, NY; and ‖‖Baylor University Medical College, Houston, TX.

STAT was supported by a research grant from The Medicines Company.

Reprints: Phillip Levy, MD, MPH, 4201 St. Antoine, Detroit, MI 48201. E-mail: plevy@med.wayne.edu.

© 2014 by Lippincott Williams & Wilkins