• Jason N Katz, Joel M Gore, Alpesh Amin, Frederick A Anderson, Joseph F Dasta, James J Ferguson, Kurt Kleinschmidt, Stephan A Mayer, Alan S Multz, W Frank Peacock, Eric Peterson, Charles Pollack, Gene Yong Sung, Andrew Shorr, Joseph Varon, Allison Wyman, Leigh A Emery, Christopher B Granger, and STAT Investigators.
• Duke Clinical Research Institute, Durham, NC 27705, USA.
• Am. Heart J. 2009 Oct 1;158(4):599-606.e1.

BackgroundLimited data are available on the care of patients with acute severe hypertension requiring hospitalization. We characterized contemporary practice patterns and outcomes for this population.MethodsSTAT is a 25-institution, US registry of consecutive patients with acute severe hypertension (>180 mm Hg systolic and/or >110 mm Hg diastolic; >140 and/or >90 for subarachnoid hemorrhage) treated with intravenous therapy in a critical care setting.ResultsOne thousand five hundred eighty-eight patients were enrolled (January 2007 to April 2008). Median age was 58 years (interquartile range 49-70 years), 779 (49%) were women, and 892 (56%) were African American; 27% (n = 425) had a prior admission for acute hypertension and 486 (31%) had chronic kidney disease. Median qualifying blood pressure (BP) was 200 (186, 220) systolic and 110 (93, 123) mm Hg diastolic. Initial intravenous antihypertensive therapies used to control BP varied, with 1,009 (64%) patients requiring multiple drugs. Median time to achieve a systolic BP <160 mm Hg (<140 mm Hg for subarachnoid hemorrhage) was 4.0 (0.8, 12) hours; 893 (60%) had reelevation to >180 (>140 for subarachnoid hemorrhage) after initial control; and 63 (4.0%) developed iatrogenic hypotension. Hospital mortality was 6.9% (n = 109) with an aggregate 90-day mortality rate of 11% (174/1,588); 59% (n = 943) had acute/worsening end-organ dysfunction during hospitalization. The 90-day readmission rate was 37% (523/1,415), of which one quarter (132/523) was due to recurrent acute severe hypertension.ConclusionThis study highlights heterogeneity in care, BP control, and outcomes of patients hospitalized with acute severe hypertension.

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