Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department

Author:

Lin Yu-TingORCID,Liu Yen-Hung,Hsiao Ya-Luan,Chiang Hsiu-Yin,Chen Pei-Shan,Chang Shih-Ni,Tsai Hsiu-Chen,Chen Chun-Hung,Kuo Chin-Chi

Abstract

Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.

Funder

Ministry of Science and Technology, Taiwan

China Medical University Hospital

Publisher

Public Library of Science (PLoS)

Subject

Multidisciplinary

Reference28 articles.

1. Hypertensive crisis;MA Rodriguez;Cardiol Rev,2010

2. Hypertensive Emergency;M Suneja;Med Clin North Am,2017

3. Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013;AT Janke;J Am Heart Assoc,2016

4. Asian management of hypertension: Current status, home blood pressure, and specific concerns in Taiwan;HM Cheng;J Clin Hypertens (Greenwich),2020

5. Hypertensive emergencies: an update;PE Marik;Curr Opin Crit Care,2011

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