Abstract: FR-PO752
Antihypertensive Treatment and Clinical Outcomes Among Patients Who Develop Severe Hypertension During Hospitalization
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Ghazi, Lama, Yale University, New Haven, Connecticut, United States
- Nugent, James, Yale University, New Haven, Connecticut, United States
- Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States
- Bakhoum, Christine Y., Yale University, New Haven, Connecticut, United States
- Wilson, Francis Perry, Yale University, New Haven, Connecticut, United States
Background
Treatment of severe hypertension (HTN) that develops during hospitalization is not guideline dependent. Compared to oral antihypertensives, treatment with IV antihypertensives could lead to more acute blood pressure (BP) reductions and worse outcomes. Our goal was to assess the effect of treatment, overall and by treatment route, on clinical outcomes in patients who develop severe HTN.
Methods
This is a multi-hospital, retrospective study of adults admitted for reasons other than HTN who develop severe HTN. We defined severe HTN as blood pressure (BP) elevation of systolic>180 or diastolic>110 mmHg. Treatment was defined as receiving antihypertensives (intravenous (IV) or oral) within 6 hours of BP elevation. We used overlap propensity score weighted Cox models to study the association between treatment and clinical outcomes.
Results
We identified 224,265 patient hospitalizations, 9% developed severe HTN and 40% were treated. Of those treated, 21% and 72% received IV and oral antihypertensives respectively. Patients who received IV compared to oral only antihypertensives were more likely female (60 vs. 54%), less likely to be Hispanic or Latino (9 vs. 12%), less likely to have comorbidities such as hypertension (79 vs. 88%) and diabetes (42% vs. 52%), less likely to be admitted to medical ward (71% vs. 87%), have higher eGFR (63 [40, 86] vs. 55 [30,82]) on admission, have higher BP on admission (168/68 vs. 153/79) and higher BP at time of severe HTN development (188/92 vs. 185/88). Patients who received IV treatment compared to no treatment had higher risk of myocardial injury, acute kidney injury, and death. However, patients who received oral antihypertensives compared to no treatment had lower risk of death (Table 1).
Conclusion
IV antihypertensive treatment was associated with worse clinical outcomes and therefore oral antihypertensives should be considered as the more preferable alternative for treatment of severe HTN without acute end organ damage.
Funding
- Other U.S. Government Support