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

PLoS One. 2021 Aug 17;16(8):e0251311. doi: 10.1371/journal.pone.0251311. eCollection 2021.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / administration & dosage*
  • Blood Pressure / drug effects*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Hypertension* / complications
  • Hypertension* / drug therapy
  • Hypertension* / mortality
  • Hypertension* / physiopathology
  • Incidence
  • Male
  • Middle Aged
  • Models, Cardiovascular*
  • Patient Discharge*
  • Retrospective Studies
  • Stroke* / drug therapy
  • Stroke* / etiology
  • Stroke* / mortality
  • Stroke* / physiopathology

Substances

  • Antihypertensive Agents

Grants and funding

This study was supported by the Ministry of Science and Technology of Taiwan (grant number: 108-2314-B-039 -038 -MY3 and 109-2321-B-468 -001 -) and China Medical University Hospital, Taichung, Taiwan (grant number: CRS-106-018 and DMR-HHC-109-6). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.