title: Association between in-hospital acute hypertensive episodes and outcomes in older trauma patients.
abstract: Although chronic hypertension is associated with long-term complications, few studies directly examine the effects of in-hospital acute hypertensive episodes in trauma patients. The aim was to determine whether there is an association between in-hospital acute hypertension and morbidity. We included trauma patients between 45 and 89 years who presented to a level I trauma center between January and September 2008. Patients were classified as either experiencing or not experiencing acute hypertensive episode(s) as defined by systolic blood pressure ≥180, or diastolic blood pressure ≥110 mmHg, or at least two readings of systolic blood pressure ≥160 or diastolic blood pressure ≥100 mmHg. The primary outcome was a composite endpoint of myocardial infarction, stroke, venous thromboembolism, new-onset atrial fibrillation, or acute kidney injury. At least one acute hypertensive episode occurred in 42.6% (69/162) of patients. A total of 10.5% patients developed the composite endpoint, 17.4% in the acute hypertensive episode group compared to 5.4% in the non-hypertensive group, p = 0.012. Patients in the acute hypertensive group were more likely to require an intensive care unit admission compared to the non-hypertensive group (33.3 versus 14.0%, p = 0.004). Of the 17 patients who developed an acute hypertensive episode and met the primary endpoint, 10 were on home antihypertensive medications. Of those, four were restarted on all medications initially, three on some, two were started on new medications, and one was not resumed on home medications. Development of acute hypertensive episode(s) in older trauma patients was associated with an increase in the composite endpoint. Prospective studies are needed.
authors: SICU, Department of Pharmacy, Yale-New Haven Hospital, New Haven, USA.
authors: Lina
authors: L
authors: Saliba
authors: Stanislaw Peter
authors: SP
authors: Stawicki
authors: Cattleya
authors: C
authors: Thongrong
authors: Sergio Daniel
authors: SD
authors: Bergese
authors: Thomas John
authors: TJ
authors: Papadimos
authors: Anthony Thomas
authors: AT
authors: Gerlach
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality*
references: Crit Care Med. 2010 Dec;38(12):2335-8
references: 20890190
references: Hypertension. 2000 Feb;35(2):539-43
references: 10679494
references: Ann Pharmacother. 2007 Feb;41(2):245-52
references: 17299013
references: JAMA. 2003 Jul 9;290(2):199-206
references: 12851274
references: JAMA. 2003 May 21;289(19):2560-72
references: 12748199
references: J Am Coll Cardiol. 2010 Jun 29;56(1):1-7
references: 20620709
references: J Am Coll Cardiol. 2005 Mar 1;45(5):705-11
references: 15734614
references: Discov Med. 2012 May;13(72):375-83
references: 22642919
references: Int J Crit Illn Inj Sci. 2011 Jul;1(2):104-9
references: 22229132
references: Am J Med. 1995 May;98(5):476-84
references: 7733127
references: Am Heart J. 2009 Oct;158(4):599-606.e1
references: 19781420
references: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD004126
references: 19821319
references: Am Heart J. 2010 Sep;160(3):521-527.e1
references: 20826262
references: Crit Care. 2007;11(2):R31
references: 17331245
references: Pharmacotherapy. 2010 Nov;30(11):1087-96
references: 20973682
references: Natl Vital Stat Rep. 2010 May;58(19):1-19
references: 25075874