• Kurt Kleinschmidt, Phillip Levy, Allison Wyman, Joseph F Dasta, Stephan A Mayer, Alpesh Amin, Charles Pollack, Andrew F Shorr, James B Froehlich, Alan S Multz, William Frank Peacock, and STAT Investigators.
• 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.
• Crit Pathw Cardiol. 2014 Jun 1; 13 (2): 66-72.

ObjectivesTo compare the characteristics, treatments, and outcomes for emergency department (ED) patients with severe hypertension by disposition (admitted versus discharged home).MethodsStudying 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.ResultsIn 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).ConclusionsED 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.

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