Emergency department patients with acute severe hypertension: a comparison of those admitted versus discharged in studying the treatment of acute hypertension registry.
OBJECTIVE
To compare the characteristics, treatments, and outcomes for emergency department (ED) patients with severe hypertension by disposition (admitted versus discharged home).


METHODS
Studying 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.


RESULTS
In 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).


CONCLUSIONS
ED 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.
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.
Kurt
K
Kleinschmidt
Phillip
P
Levy
Allison
A
Wyman
Joseph F
JF
Dasta
Stephan A
SA
Mayer
Alpesh
A
Amin
Charles
C
Pollack
Andrew F
AF
Shorr
James B
JB
Froehlich
Alan S
AS
Multz
William Frank
WF
Peacock
D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents