OBJECTIVE:: To determine the demographic and clinical features, hospital complications, and predictors of 90-day mortality in neurologic patients with acute severe hypertension. DESIGN:: Studying the Treatment of Acute hyperTension (STAT) was a multicenter (n = 25) observational registry of adult critical care patients with severe hypertension treated with intravenous therapy. SETTING:: Emergency department or intensive care unit. PATIENTS:: A qualifying blood pressure measurement >180 mm Hg systolic or >110 mm Hg diastolic (>140/90 mm Hg for subarachnoid hemorrhage) was required for inclusion in the STAT registry. Patients with a primary neurologic admission diagnosis were included in the present analysis. INTERVENTIONS:: All patients were treated with at least one parenteral (bolus or continuous infusion) antihypertensive agent. MEASUREMENTS AND MAIN RESULTS:: Of 1,566 patients included in the STAT registry, 432 (28%) had a primary neurologic diagnosis. The most common diagnoses were subarachnoid hemorrhage (38%), intracerebral hemorrhage (31%), and acute ischemic stroke (18%). The most common initial drug was labetalol (48%), followed by nicardipine (15%), hydralazine (15%), and sodium nitroprusside (13%). Mortality at 90 days was substantially higher in neurologic than in non-neurologic patients (24% vs. 6%, p < .0001). Median initial blood pressure was 183/95 mm Hg and did not differ between survivors and nonsurvivors. In a multivariable analysis among neurologic patients who died experienced lower minimal blood pressure values (median 103/45 vs. 118/55 mm Hg, p < .0001) and were less likely to experience recurrent hypertension requiring intravenous treatment (29% vs. 51%, p = .0001) than those who survived. Mortality was also associated with an increased frequency of neurologic deterioration (32% vs. 10%, p < .0001). CONCLUSION:: Neurologic emergencies account for approximately 30% of hospitalized patients with severe acute hypertension, and the majority of those who die. Mortality in hypertensive neurologic patients is associated with lower minimum blood pressure values, less rebound hypertension, and a higher frequency of neurologic deterioration. Excessive blood pressure reduction may contribute to poor outcome after severe brain injury.

STUDY OBJECTIVE: To assess antihypertensive treatment practices and outcomes for patients with acute severe hypertension requiring hospitalization. DESIGN: Subanalysis of a multicenter, observational, cross-sectional study. DATA SOURCE: The STAT registry (data from 25 hospitals). PATIENTS: A total of 1184 consecutive adults with acute severe hypertension (systolic blood pressure [SBP] ≥ 180 mm Hg, diastolic blood pressure ≥ 110 mm Hg), without a neurologic reason for admission, receiving two or more intermittent intravenous antihypertensive doses or a continuous intravenous infusion within 24 hours of hospitalization. MEASUREMENTS AND MAIN RESULTS: Patients started intravenous antihypertensive therapy 1.3 (median [interquartile range (IQR) 0.5-3.2]) hours after the qualifying SBP (median 204 [IQR 190-221] mm Hg). Labetalol (27%), metoprolol (21%), and nitroglycerin (20%) were the most frequent initial intravenous choices. For the 43% of patients administered two or more intravenous agents sequentially, the 24% receiving three or more, and the 8% receiving four or more, median SBPs at the time of the second, third, and fourth additions were 186 (IQR 168-211), 176 (IQR 152-196), and 164 (IQR 143-193) mm Hg, respectively. Most common continuous intravenous infusions were nitroglycerin (30%), nicardipine (13%), and labetalol (7%). After the first intravenous agent, an SBP decrease of 10-25% was achieved at 1 and 6 hours in 48% and 72%, respectively. Of the 6% without at least a 10% decrease in SBP during the entire hospitalization, labetalol (28%), hydralazine (21%), and metoprolol (17%) were the most frequent initial intravenous choices. Hypotension (SBP ≤ 90 mm Hg) occurred in 5% and was most common with intravenous nitroglycerin (39%). Oral antihypertensives were started within 1 and 6 hours after the first intravenous therapy in 13% and 34% of patients, respectively, with many patients (61%) receiving three or more oral agents during hospitalization. CONCLUSION: Pharmacologic treatment of acute severe hypertension in patients with nonneurologic causes is heterogeneous and often not consistent with Joint National Committee recommendations. Patients received numerous intravenous agents, experienced variable decreases in SBP, often failed to receive timely oral therapy, and a clinically relevant proportion developed hypotension.

BACKGROUND: Little is known about the association of kidney dysfunction and outcome in acute severe hypertension. This study aimed to measure the association between baseline chronic kidney disease (estimated glomerular filtration rate), acute kidney injury (AKI, decrease in estimated glomerular filtration rate > or =25% from baseline) and outcome in patients hospitalized with acute severe hypertension. METHODS AND RESULTS: The Studying the Treatment of Acute Hypertension (STAT) registry enrolled patients with acute severe hypertension, defined as > or =1 blood pressure measurement >180 mm Hg systolic and/or >110 mm Hg diastolic and treated with intravenous antihypertensive therapy. Data were compared across groups categorized by admission estimated glomerular filtration rate and AKI during admission. On admission, 79% of the cohort (n=1566) had at least mild chronic kidney disease (estimated glomerular filtration rate/min in 46%,/min in 22%). Chronic kidney disease patients were more likely to develop heart failure (P CONCLUSIONS: Chronic kidney disease is a common comorbidity among patients admitted with acute severe hypertension, and AKI is a frequent form of acute target organ dysfunction, particularly in those with baseline chronic kidney disease. Any degree of AKI is associated with a greater risk of morbidity and mortality.