Association of normal systolic blood pressure in the emergency department with higher in-hospital mortality among hypertensive patients

J Clin Hypertens (Greenwich). 2019 Dec;21(12):1841-1848. doi: 10.1111/jch.13727. Epub 2019 Nov 19.

Abstract

Blood pressure is commonly elevated at the hospital emergency department (ED), especially among hypertensive patients. The aim of the study was to determine the association between ED systolic blood pressure (SBP) and in-hospital mortality among hypertensive patients. The authors retrospectively retrieved records of hypertensive patients who were hospitalized during a seven-year period. The authors examined the association between SBP and in-hospital mortality rate, adjusted for demographics, heart rate, comorbidities, laboratory results, and hospital ward. Overall, 96 423 patients were included. Compared to patients with SBP 110-139 mm Hg, the adjusted odds ratios were 4.1 (95% CI, 3.7-4.6) with SBP <90, 1.6 (95% CI, 1.4-1.7) with SBP 90-109, 0.7 (95% CI, 0.6-0.7) with SBP 140-159, 0.7 (95% CI, 0.6-0.7) with SBP 160-179, 0.7 (95% CI, 0.6-0.8) with SBP 180-199, 0.9 (95% CI, 0.7-1.1) with SBP 200-219, and 1.1 (95% CI, 0.7-1.7) with SBP ≥220 mm Hg. Thus, SBP levels of 110-139 mm Hg were associated with higher in-hospital mortality in comparison with elevated SBP up to 200 mm Hg.

Keywords: blood pressure; emergency departments; essential; hypertension; in-hospital mortality.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / physiology*
  • Blood Pressure Determination / methods
  • Case-Control Studies
  • Comorbidity
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Heart Rate / physiology
  • Hospital Mortality / trends*
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Hypertension / mortality*
  • Hypertension / physiopathology
  • Israel / epidemiology
  • Male
  • Middle Aged
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers

Substances

  • Antihypertensive Agents