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    Patterns of antihypertensive treatment in patients with acute severe hypertension from a nonneurologic cause: Studying the Treatment of Acute Hypertension (STAT) registry

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    Authors
    Devlin, John W.
    Dasta, Joseph F.
    Kleinschmidt, Kurt
    Roberts, Russel J.
    Lapointe, Marc
    Varon, Joseph
    Anderson, Frederick A. Jr.
    Wyman, Allison
    Granger, Christopher B.
    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2010-11-27
    Keywords
    Acute Disease
    Administration, Oral
    Adult
    Aged
    Antihypertensive Agents
    Blood Pressure
    Cross-Sectional Studies
    Drug Therapy, Combination
    Female
    Hospitalization
    Humans
    Hypertension
    Infusions, Intravenous
    Male
    Middle Aged
    Physician's Practice Patterns
    Prospective Studies
    Registries
    Retrospective Studies
    Severity of Illness Index
    United States
    Cardiovascular Diseases
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1592/phco.30.11.1087
    Abstract
    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.
    Source
    Pharmacotherapy. 2010 Nov;30(11):1087-96. Link to article on publisher's site
    DOI
    10.1592/phco.30.11.1087
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27308
    PubMed ID
    20973682
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1592/phco.30.11.1087
    Scopus Count
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    STAT Publications

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