Mayer, S. A.Kurtz, P.Wyman, AllisonSung, G. Y.Multz, A. S.Varon, JosephGranger, Christopher B.Kleinschmidt, K.Lapointe, M.Peacock, W. F.Katz, J. N.Gore, Joel M.O'Neil, B.Anderson, Frederick A. Jr.2022-08-232022-08-232011-10-152011-11-04Crit Care Med. 2011 Oct;39(10):2330-6. <a href="http://dx.doi.org/10.1097/CCM.0b013e3182227238">Link to article on publisher's site</a>0090-3493 (Linking)10.1097/CCM.0b013e318222723821666448https://hdl.handle.net/20.500.14038/27307OBJECTIVE:: 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.en-USHypertensionCardiovascular DiseasesHealth Services ResearchJournal Articlehttps://escholarship.umassmed.edu/cor_stat/12330461cor_stat/1