Effect of Joint National Committee VII report on hospitalizations for hypertensive emergencies in the United States

Abstract

Approximately 1% to 2% of patients with hypertension will have a hypertensive emergency at some time in their life. However, no data are available on the frequency of hospitalizations for a hypertensive emergency after the publication of the Seventh Joint National Committee (JNC7) on the prevention, detection, evaluation, and treatment of high blood pressure. We sought to explore the changes in the frequency of hospitalizations and in-hospital mortality for hypertensive emergencies before and after the JNC7 report. Using the Nationwide Inpatient Sample from 2000 to 2007, adult patients (aged ≥18 years) who were hospitalized with a diagnosis of a hypertensive emergency were identified through appropriate "International Classification of Diseases, 9th revision, Clinical Modification" codes. A total of 456,259 hospitalizations with the diagnosis of hypertensive emergency occurred from the start of calendar year 2000 to the end of calendar year 2007. After adjusting for the United States census for 2000 and American Community Survey estimates for 2007 for adults, the frequency of hospitalizations with a hypertensive emergency increased in United States adults from 101/100,000 in 2000 to 111/100,000 in 2007, an average increase of about 1.11%. Despite the increase in hospitalizations, the all-cause in-hospital mortality rate decreased from 2.8% in the pre-JNC7 era to 2.6% in the post-JNC7 era (odds ratio 0.91, 95% confidence interval 0.86 to 0.96). In conclusion, the results of the present study have shown that although the number of patients with hypertensive emergency increased from 2000 to 2007, the mortality rates decreased significantly after the JNC7 guidelines.