Severe inpatient hypertension prevalence and blood pressure response to antihypertensive treatment

Abstract

Severe hypertension (HTN) that develops during hospitalization is more common than admission for HTN; however, it is poorly studied, and treatment guidelines are lacking. Our goal is to characterize hospitalized patients who develop severe HTN and assess blood pressure (BP) response to treatment. This is a multi-hospital retrospective cohort study of adults admitted for reasons other than HTN who developed severe HTN. The authors defined severe inpatient HTN as the first documented BP elevation (systolic BP > 180 or diastolic BP > 110) at least 1 hour after admission. Treatment was defined as receiving antihypertensives (intravenous [IV] or oral) within 6h of BP elevation. As a measure of possible overtreatment, the authors studied the association between treatment and time to mean arterial pressure (MAP) drop ≥ 30% using the Cox proportional hazards model. Among 224 265 hospitalized adults, 10% developed severe HTN of which 40% were treated. Compared to patients who did not develop severe HTN, those who did were older, more commonly women and black, and had more comorbidities. Incident MAP drop ≥ 30% among treated and untreated patients with severe HTN was 2.2 versus 5.7/1000 person-hours. After adjustment, treated versus. untreated patients had lower rates of MAP drop ≥ 30% (hazard rate [HR]: 0.9 [0.8, 0.99]). However, those receiving only IV treatment versus untreated had greater rates of MAP drop ≥ 30% (1.4 [1.2, 1.7]). Overall, the authors found that clinically significant MAP drop is observed among inpatients with severe HTN irrespective of treatment, with greater rates observed among patients treated only with IV antihypertensives. Further research is needed to phenotype inpatients with severe HTN.

Keywords: antihypertensive therapy; blood pressure response; electronic health records; hypertension; inpatient.

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FIGURE 2

Study flow diagram. YNHHS: Yale New Haven Health System; ICU: intensive care unit; BP: blood pressure

FIGURE 3

(A). Absolute change in blood pressure following severe hypertension development by treatment status. MAP: mean arterial pressure; SBP: systolic blood pressure; DBP: diastolic blood pressure, Tx: treated within 6 hours of developing severe hypertension; Untx: untreated within 6 hours of developing severe hypertension. *: statistically significant difference between treated and untreated (p < .001). Median values of absolute change are shown in the figure. Absolute change in blood pressure (MAP, SBP, DBP) 0–6 hours from developing severe inpatient hypertension: blood pressure at time of severe inpatient hypertension – minimum blood pressure recorded within 0–6 hours of developing severe inpatient hypertension. (B). Percent Change in Blood Pressure following Severe Hypertension Development by Treatment Status. MAP: mean arterial pressure; SBP: systolic blood pressure; DBP: diastolic blood pressure, Tx: treated within 6 hours of developing severe hypertension; Untx: untreated within 6 hours of developing severe hypertension. *: statistically significant difference between treated and untreated (p < .001). All values on y‐axis refer to percent change in blood pressures. Median values of percent change are shown in the figure. Percent change in blood pressure (MAP, SBP, DBP) 0–6 hours from developing severe inpatient hypertension: blood pressure at time of severe inpatient hypertension – minimum blood pressure recorded within 0–6 hours of developing severe inpatient hypertension