Few Cardiovascular Events in Patients With Hypertensive Urgency
A new retrospective study concludes that the rate of cardiovascular events among patients experiencing asymptomatic hypertensive urgency (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) is low.
Researchers sought to describe the prevalence of hypertensive urgency and the characteristics and short-term outcomes of these patients, as well as determine whether referral to the hospital is linked to better outcomes than outpatient management. To achieve that goal, the authors conducted a retrospective cohort study that included all patients presenting with hypertensive urgency to an office in the Cleveland Clinic health system between January 1, 2008, and December 31, 2013. Pregnant women and patients referred to the hospital for symptoms or treatment of other conditions were excluded, with final follow-up completed on June 30, 2014. Data were assessed from October 31, 2014, to May 31, 2015.
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Among 2,199,019 unique patient office visits, 59,836 met the definition of hypertensive urgency. After excluding 851 patients, the researchers evaluated data from 58,535 patients who presented to outpatient practices with hypertensive urgency, with 0.7% of patients being referred to the hospital the same day. Overall, less than 1% of patients experienced cardiovascular events, and the number of major adverse cardiovascular events (MACE) experienced up to 6 months later did not differ greatly between patients referred to the hospital and those who were sent home. In addition, patients sent home were more likely to have uncontrolled hypertension at 1 month, but not at 6 months, while patients sent home had lower hospital admission rates at 7 days at 8 to 30 days.
“Hypertensive urgency is common, but the rate of MACE in asymptomatic patients is very low. Visits to the emergency department were associated with more hospitalizations, but not improved outcomes,” the authors wrote, adding that “most patients still had uncontrolled hypertension 6 months later.”
—Mark McGraw
Reference
Patel KK, Young Y, Howell EH, et al. Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting [published online June 13, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.1509.