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Acute Severe Hypertension has High Morbidity, Mortality, and Readmission Rates: Results from the STAT Registry

Acute Severe Hypertension has High Morbidity, Mortality, and Readmission Rates: Results from the STAT Registry .

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Acute Severe Hypertension has High Morbidity, Mortality, and Readmission Rates: Results from the STAT Registry

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  1. Acute Severe Hypertension has High Morbidity, Mortality, and Readmission Rates: Results from the STAT Registry CB Granger, J Gore, J Katz, K Kleinschmidt, A Wyman, F Peacock, F Anderson, on behalf of the STAT Investigators. Presented at the European Society of Cardiology Annual Meeting, September 2, 2008.

  2. STAT Steering Committee Albert Einstein College of Medicine Alan S Multz Cleveland Clinic W Frank Peacock Columbia University Stephan A Mayer Duke University Christopher Granger* Eric Peterson Ohio State University Joseph F Dasta Uniformed Services University Andrew F Shorr University of California Alpesh Amin University of Massachusetts Fred Anderson Joel Gore University of Pennsylvania Charles Pollack University of Southern California Gene Yong Sung University of Texas at Houston James Ferguson Joseph Varon University of Texas Southwestern Kurt Kleinschmidt Project and data coordinated by and analyzed by Center for Outcomes Research, University of Massachusetts, Worcester, MA *Chair

  3. Joseph Varon Phil Levy Richard Nowak John Devlin Jim Froehlich Brian O'Neil Marc Lapoint Kurt Kleinschmidt W Frank Peacock Joel M Gore Charles Pollack Jon Schrock Participating Investigators in STAT (25 US Centers) Lala Dunbar John Cienki Stephan S Mayer Anthony Gerlach Deborah Diercks Adam Singer Gene Yong Sung Jason Katz Namarata Patil David Cline Icima Fergus Brian Tiffany Worcester MA Boston, MA Stony Brook, NY Royal Oak, MI New York, NY Ann Arbor, MI Detroit, MI (3) Philadelphia, PA Cleveland, OH Sacramento, CA Columbus, OH Winston-Salem, NC Durham, NC Charleston, SC Chandler, AZ Dallas, TX New Orleans, LA Houston, TX Miami, FL

  4. Background • Acute severe hypertension is common – occurring in 1-2% of the 72 million US patients with hypertension, and comprising up to 25% of visits in busy urban emergency departments • Contemporary patient features, management and outcomes are not well known • Traditional definitions of who needs intensive therapy have been based on target organ dysfunction

  5. Goal Improve understanding of clinical conditions of acute severe hypertension managed in a critical care setting and treated with IV antihypertensive drugs

  6. Inclusion Criteria • >18 years of age • Presenting to the hospital with acute severe HTN • Treated in a critical care setting • Acute severe HTN treated with an IV agent • Severe hypertension • At least one SBP >180 mmHg and/or • At least one DBP >110 mmHg • SAH patients with SBP >140 and/or DBP >90

  7. Study Population Patients 1,588 Age - median (IQR) 58 (49, 70) Female sex 49% Black race 56% White race 34% Qualifying BP (mmHg) Systolic 200 (186, 220) Diastolic 110 (93, 123) LOS - median (IQR) 5 days (2, 9)

  8. Patient Demographics

  9. Predisposing Factors Contributing to Hypertensive Event (35%)

  10. Primary Admitting Diagnosis

  11. Resource Use Procedure/care % Brain imaging (CT, MRI) 48 Admitted to ICU 48 Echocardiography 45 Arterial line 25 Mechanical ventilation 18 Funduscopic exam 13

  12. Time from Qualifying BP to Initiation of IV Therapy

  13. First IV Antihypertensive

  14. Number of Different IV Antihypertensives During Hospitalization by First Received

  15. Median Systolic BP Over 24 h by First IV Antihypertensive

  16. STAT Results • Median time to SBP of <160 mmHg: 4 hrs • 60% increased to >180 after initial control • 4% had iatrogenic hypotension • 29% had recurrent, severe HTN necessitating reinstitution of parenteral therapy • 65% had no documentation of follow-up appointment being either scheduled or attended

  17. Patient Outcomes *n=1588 (all patients); †n=1415 (all patients alive at discharge and with 90-day follow-up)

  18. Short-Term (2 to 6 month) Outcomes Acute Condition Death Rehospitalization ACS1,2,3 5-7% 30% CHF4 8.5% 26% Severe Hypertension5 11% 37% • OASIS-5 NEJM 2006 • GUSTO IIb NEJM 1996 • GRACE JAMA 2007 • IMPACT-HF J Cardiac Failure 2004 • STAT Registry results

  19. Summary • Acute severe hypertension • Recurrent condition • Associated with poor medical adherence • Heterogeneous management: ICU admission, drugs used, BP targets • Alarmingly low rates of follow-up • High mortality and morbidity, especially with new or worsening end-organ damage • Major need to improve prevention and treatment of this understudied condition

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