title: Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry.
abstract: OBJECTIVE
  To determine the demographic and clinical features, hospital complications, and predictors of 90-day mortality in neurologic patients with acute severe hypertension.
  
  
  METHODS
  Studying the Treatment of Acute hyperTension (STAT) was a multicenter (n=25) observational registry of adult critical care patients with severe hypertension treated with intravenous therapy.
  
  
  METHODS
  Emergency department or intensive care unit.
  
  
  METHODS
  A qualifying blood pressure measurement>180 mm Hg systolic or >110 mm Hg diastolic (>140/90 mm Hg for subarachnoid hemorrhage) was required for inclusion in the STAT registry. Patients with a primary neurologic admission diagnosis were included in the present analysis.
  
  
  METHODS
  All patients were treated with at least one parenteral (bolus or continuous infusion) antihypertensive agent.
  
  
  RESULTS
  Of 1,566 patients included in the STAT registry, 432 (28%) had a primary neurologic diagnosis. The most common diagnoses were subarachnoid hemorrhage (38%), intracerebral hemorrhage (31%), and acute ischemic stroke (18%). The most common initial drug was labetalol (48%), followed by nicardipine (15%), hydralazine (15%), and sodium nitroprusside (13%). Mortality at 90 days was substantially higher in neurologic than in non-neurologic patients (24% vs. 6%, p<.0001). Median initial blood pressure was 183/95 mm Hg and did not differ between survivors and nonsurvivors. In a multivariable analysis, neurologic patients who died experienced lower minimal blood pressure values (median 103/45 vs. 118/55 mm Hg, p<.0001) and were less likely to experience recurrent hypertension requiring intravenous treatment (29% vs. 51%, p=.0001) than those who survived. Mortality was also associated with an increased frequency of neurologic deterioration (32% vs. 10%, p<.0001).
  
  
  CONCLUSIONS
  Neurologic emergencies account for approximately 30% of hospitalized patients with severe acute hypertension, and the majority of those who die. Mortality in hypertensive neurologic patients is associated with lower minimum blood pressure values, less rebound hypertension, and a higher frequency of neurologic deterioration. Excessive blood pressure reduction may contribute to poor outcome after severe brain injury.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA. sam14@columbia.edu
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Pedro
authors.initials: P
authors.lastname: Kurtz
authors.forename: Allison
authors.initials: A
authors.lastname: Wyman
authors.forename: Gene Y
authors.initials: GY
authors.lastname: Sung
authors.forename: Alan S
authors.initials: AS
authors.lastname: Multz
authors.forename: Joseph
authors.initials: J
authors.lastname: Varon
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Kurt
authors.initials: K
authors.lastname: Kleinschmidt
authors.forename: Marc
authors.initials: M
authors.lastname: Lapointe
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Jason N
authors.initials: JN
authors.lastname: Katz
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Brian
authors.initials: B
authors.lastname: O'Neil
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000401:mortality*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012720:Severity of Illness Index