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dc.contributor.authorPeacock, Frank
dc.contributor.authorAmin, Alpesh
dc.contributor.authorGranger, Christopher B.
dc.contributor.authorPollack, Charles V. Jr.
dc.contributor.authorLevy, Phillip D.
dc.contributor.authorNowak, Richard
dc.contributor.authorKleinschmidt, Kurt
dc.contributor.authorVaron, Joseph
dc.contributor.authorWyman, Allison
dc.contributor.authorGore, Joel M.
dc.date2022-08-11T08:08:09.000
dc.date.accessioned2022-08-23T15:44:25Z
dc.date.available2022-08-23T15:44:25Z
dc.date.issued2011-10-10
dc.date.submitted2011-11-04
dc.identifier.citationAm J Emerg Med. 2011 Oct;29(8):855-862. Epub 2010 May 1. <a href="http://dx.doi.org/10.1016/j.ajem.2010.03.022">Link to article on publisher's site</a>
dc.identifier.issn0735-6757 (Linking)
dc.identifier.doi10.1016/j.ajem.2010.03.022
dc.identifier.pmid20825913
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27310
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=20825913&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ajem.2010.03.022
dc.subjectHypertension
dc.subjectHeart Failure
dc.subjectCardiovascular Diseases
dc.subjectHealth Services Research
dc.titleHypertensive heart failure: patient characteristics, treatment, and outcomes
dc.typeJournal Article
dc.source.journaltitleThe American journal of emergency medicine
dc.source.volume29
dc.source.issue8
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_stat/4
dc.identifier.contextkey2330464
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathcor_stat/4
dc.contributor.departmentDepartment of Medicine, Division of Cardiovascular Medicine
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages855-862


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