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    Hypertensive heart failure: patient characteristics, treatment, and outcomes

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    Authors
    Peacock, Frank
    Amin, Alpesh
    Granger, Christopher B.
    Pollack, Charles V. Jr.
    Levy, Phillip D.
    Nowak, Richard
    Kleinschmidt, Kurt
    Varon, Joseph
    Wyman, Allison
    Gore, Joel M.
    UMass Chan Affiliations
    Department of Medicine, Division of Cardiovascular Medicine
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2011-10-10
    Keywords
    Hypertension
    Heart Failure
    Cardiovascular Diseases
    Health Services Research
    
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    http://dx.doi.org/10.1016/j.ajem.2010.03.022
    Abstract
    BACKGROUND: Acute heart failure (AHF) is a common, poorly characterized manifestation of hypertensive emergency. We sought to describe characteristics, treatment, and outcomes of patients with severe hypertension complicated by AHF. METHODS AND RESULTS: The observational retrospective Studying the Treatment of Acute hypertension (STAT) registry records data on emergency department and hospitalized patients receiving intravenous therapy for blood pressure (BP) greater than 180/110 mm Hg in 25 US hospitals. A subset of patients with HF was defined as pulmonary edema on chest x-ray (CXR) or an elevated B-type natriuretic peptide level (BNP > 500 or NTproBNP > 900 pg/mL) in patients with creatinine level 2.5 mg/dL or less. Remaining STAT patients, after excluding those with a primary neurologic diagnosis, constitute the non-HF cohort. An adverse composite outcome was defined as mechanical ventilation, intensive care unit (ICU) admission, hospital length of stay more than 1 week, or death within 30 days. Of 1199 patients, 302 (25.2%) had AHF. Acute HF patients and non-AHF patients were similar in age, sex, and overall mortality, but AHF patients were more commonly African American, with a history of HF, diabetes or chronic obstructive pulmonary disease, and prior hypertension admissions. Heart failure patients had higher creatinine and natriuretic peptide levels but lower ejection fraction. They were more likely admitted to the ICU; receive electrocardiograms, bilevel positive airway pressure ventilation, and CXRs; and be readmitted within 90 days. Finally, BP decreases lower than 120 mm Hg within 12 hours were associated with an increased rate of the composite adverse outcome. CONCLUSIONS: Acute HF as a manifestation of hypertensive emergency is common, more likely in African Americans, and requires more clinical resources than patients with non-HF-related severe hypertension. Accurate BP control is critical, as declines less than 120 mm Hg were associated with increased adverse event rates.
    Source
    Am J Emerg Med. 2011 Oct;29(8):855-862. Epub 2010 May 1. Link to article on publisher's site
    DOI
    10.1016/j.ajem.2010.03.022
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27310
    PubMed ID
    20825913
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ajem.2010.03.022
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