Abstract
Although chronic hypertension is associated with long-term complications, few studies directly examine the effects of in-hospital acute hypertensive episodes in trauma patients. The aim was to determine whether there is an association between in-hospital acute hypertension and morbidity. We included trauma patients between 45 and 89 years who presented to a level I trauma center between January and September 2008. Patients were classified as either experiencing or not experiencing acute hypertensive episode(s) as defined by systolic blood pressure ≥180, or diastolic blood pressure ≥110 mmHg, or at least two readings of systolic blood pressure ≥160 or diastolic blood pressure ≥100 mmHg. The primary outcome was a composite endpoint of myocardial infarction, stroke, venous thromboembolism, new-onset atrial fibrillation, or acute kidney injury. At least one acute hypertensive episode occurred in 42.6 % (69/162) of patients. A total of 10.5 % patients developed the composite endpoint, 17.4 % in the acute hypertensive episode group compared to 5.4 % in the non-hypertensive group, p = 0.012. Patients in the acute hypertensive group were more likely to require an intensive care unit admission compared to the non-hypertensive group (33.3 versus 14.0 %, p = 0.004). Of the 17 patients who developed an acute hypertensive episode and met the primary endpoint, 10 were on home antihypertensive medications. Of those, four were restarted on all medications initially, three on some, two were started on new medications, and one was not resumed on home medications. Development of acute hypertensive episode(s) in older trauma patients was associated with an increase in the composite endpoint. Prospective studies are needed.
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Howden LM, Meyer JA (2010) Age and sex composition: 2010. United States Census Bureau. 2010. Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf. Accessed May 2011
Hajjar I, Kotchen TA (2003) Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 290:199–206
Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD (2012) Advances in the management acute hypertension: a concise review. Discov Med 72:375–383
Ogden LG, He J, Lydick E, Whelton PK (2000) Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension 35:539–543
Gerlach AT (2006) Special considerations in the management of trauma patients. In: Schumock G, Brundage D, Richardson M et al (eds) Pharmacotherapy Self-Assessment Program, 5th edn. Critical care and transplantation. American College of Clinical Pharmacy, Kansas City, MO: pp 111–138
Evans D, Gerlach AT, Christy JM et al (2011) Pre-injury polypharmacy as predictor of outcomes in trauma patients. Int J Crit Illn Inj Sci 1:104–109
Xu J, Kochanek KD, Murphy SL et al (2010) Deaths: final data for 2007. Natl Vital Stat Rep 58:1–136
Devlin JW, Dasta JF, Kleinschmidt K et al (2010) Patterns of antihypertensive use in patients with acute severe hypertension from a non-neurological cause: studying the treatment of acute hypertension (STAT) registry. Pharmacotherapy 30:1087–1096
Chobanian AV, Bakris GL, Black HR et al (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA 289:2560–2572
Gore JM, Peterson E, Amin A et al (2010) Predictors of 90-day readmission among patients with acute severe hypertension. The cross-sectional observational studying the treatment of acute hypertension (STAT) study. Am Heart J 160(521–527):e1
Mehta RL, Kellum JA, Shah SV et al (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31
Wachtell K, Hornestam B, Lehto M et al (2005) Cardiovascular morbidity and mortality in hypertensive patients with a history of atrail fibrillation. J Am Coll Cardiol 45:705–711
Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE (1995) The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med 98:476–484
Goldhaber SZ (2010) Risk Factors for venous thromboembolism. J Am Coll Cardiol 56:1–7
Katz JN, Gore JM, Amin A et al (2009) Practice patterns, outcomes, and end-organ dysfunction for patients with acute severe hypertension: the studying the treatment of acute hypertension (STAT) registry. Am Heart J 158(599–606):e1
Gerlach AT, Dasta JF (2007) Dexmedetomidine: an updated review. Ann Pharmcother 41:245–254
Wijeysundera DN, Bender JS, Beattie WS (2009) Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev 4:CD004126
Chatterjee A, DePriest K, Blair R, Bowton D, Chin R (2010) Results of a survey of blood pressure monitoring by intensivist in critically ill patients: a preliminary study. Crit Care Med 38:2335–2338
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Saliba, L., Stawicki, S.P., Thongrong, C. et al. Association between in-hospital acute hypertensive episodes and outcomes in older trauma patients. Intern Emerg Med 9, 553–558 (2014). https://doi.org/10.1007/s11739-013-0984-0
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DOI: https://doi.org/10.1007/s11739-013-0984-0