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Sponsored by a grant from The Medicines Company to the Center for Outcomes Research, University of Massachusetts Medical School Acute Severe Hypertension.

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Presentation on theme: "Sponsored by a grant from The Medicines Company to the Center for Outcomes Research, University of Massachusetts Medical School Acute Severe Hypertension."— Presentation transcript:

1 Sponsored by a grant from The Medicines Company to the Center for Outcomes Research, University of Massachusetts Medical School 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 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 3 Participating Investigators in STAT (25 US Centers) Cleveland, OH Worcester MA Dallas, TX New York, NY Philadelphia, PA Houston, TX Durham, NC Sacramento, CA Columbus, OH Miami, FL Boston, MA Detroit, MI (3) New Orleans, LA Chandler, AZ Royal Oak, MI Stony Brook, NY Charleston, SC Winston-Salem, NC Ann Arbor, MI 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 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

4 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 5 Goal Improve understanding of clinical conditions of acute severe hypertension managed in a critical care setting and treated with IV antihypertensive drugs

6 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 7 Study Population Patients1,588 Age - median (IQR) 58 (49, 70) Female sex49% Black race56% White race34% Qualifying BP (mmHg) Systolic200 (186, 220) Systolic200 (186, 220) Diastolic110 (93, 123) Diastolic110 (93, 123) LOS - median (IQR) 5 days (2, 9)

8 8 Patient Demographics Medical history % Hypertension89 Tobacco or alcohol use 38 Diabetes35 Chronic kidney disease 31 End stage renal disease End stage renal disease11 Previous hospitalization for HTN 27 Neurological event 23 Drug abuse 15

9 9 Presenting Characteristics Symptoms% Shortness of breath 29 Chest pain 26 Headache23 Altered mental status 20 Weak and dizzy 17

10 10 Predisposing Factors Contributing to Hypertensive Event (35%) Factors% Medication non-adherence 25 Chronic Chronic16 Current Current10 Missed or incomplete dialysis 3 Anxiety/psychosocial reaction 2 Drug abuse 11

11 11 Primary Admitting Diagnosis

12 12 Resource Use Procedure/care % Brain imaging (CT, MRI) 48 Admitted to ICU48 Echocardiography 45 Arterial line25 Mechanical ventilation 18 Funduscopic exam13

13 13 Time from Qualifying BP to Initiation of IV Therapy

14 14 First IV Antihypertensive

15 15 Number of Different IV Antihypertensives During Hospitalization by First Received

16 16 Median Systolic BP Over 24 h by First IV Antihypertensive

17 17 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

18 18 Patient Outcomes *n=1588 (all patients); †n=1415 (all patients alive at discharge and with 90-day follow-up)

19 19 Short-Term (2 to 6 month) Outcomes Acute ConditionDeathRehospitalization ACS 1,2,3 5-7%30% CHF 4 8.5%26% Severe Hypertension 5 11%37% 1.OASIS-5 NEJM GUSTO IIb NEJM GRACE JAMA IMPACT-HF J Cardiac Failure STAT Registry results

20 20 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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