• J Hosp Med · Mar 2012

    Severe acute hypertension among inpatients admitted from the emergency department.

    • Andrew F Shorr, Marya D Zilberberg, Xiaowu Sun, Richard S Johannes, Vikas Gupta, and Ying P Tabak.
    • Pulmonary and Critical Care Medicine Service, Washington Hospital Center, Washington, DC 20010, USA. andrew.shorr@gmail.com
    • J Hosp Med. 2012 Mar 1;7(3):203-10.

    BackgroundHospitalists often treat patients with severe acute hypertension (AH) presenting to the hospital. Little is known about the epidemiology of this syndrome.ObjectiveTo examine the prevalence of severe AH in patients admitted through the emergency department (ED) and its associated outcomes.DesignA cohort study using retrospectively collected vital signs and other clinical data.PatientsA total of 1,290,804 adults admitted between 2005 and 2007.SettingOne hundred fourteen acute-care hospitals.MeasurementsSevere 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).ResultsSevere 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).ConclusionsSevere 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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