Hypertensive Emergencies Up, But Deaths Down

September 30, 2011

September 29, 2011 (Little Rock, Arkansas) — The number of patients admitted to the hospital suffering from hypertensive emergencies has risen since 2000, but deaths resulting from these hospitalizations have dropped, new figures show [1].

The study is one of the few looks at the subject of hypertensive crises, which tend to be ignored in guidelines, says lead author Dr Abhishek Deshmukh (University of Arkansas for Medical Sciences, Little Rock). He and his colleagues report their findings online September 3, 2011 in the American Journal of Cardiology.

And although Deshmukh believes the US Seventh Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommendations on blood-pressure management, which were issued in 2003, may have contributed to the reduction in mortality seen in his study, he told heartwire he would love to see more attention being paid to hypertensive emergencies, which were not specifically mentioned in JNC 7.

He explains that a hypertensive emergency--also known as acute hypertension--exists when blood pressure reaches levels that are damaging organs, generally at values exceeding 180 mm Hg systolic or 120 mm Hg diastolic, but they can occur at even lower levels in patients whose BP had not been previously high.

In their study, he and his colleagues show that the frequency of hospitalizations with a diagnosis of hypertensive emergency inched up from 101/100 000 in 2000 to 111/100 000 in 2007, an average increase of about 1.1%. But despite this rise in admissions, in-hospital deaths fell from 2.8% in the pre-JNC 7 era (2000–2003) to 2.6% in the post-JNC 7 era (2004–2007; odds ratio 0.91).

The authors speculate that the improvement in mortality is likely due to increased awareness of how to treat hypertension among doctors following publication of the JNC 7 guidance.

I hope that in JNC 8 they mention something about how to handle patients admitted with hypertensive emergencies.

But there is much room for further improvement, which would help in the management of hypertensive emergencies, says Deshmukh. The JNC 8 guidelines, which will be the next US advice on blood-pressure management, have been eagerly awaited for some time and it is hoped they will be issued by the end of this year or sometime in 2012.

"I hope that in JNC 8 they mention something about how to handle patients admitted with hypertensive emergencies and perhaps list appropriateness criteria as to who should get hospitalized with very high blood pressure," he notes. And Deshmukh says he would also like to see JNC 8 "focus on what blood pressure it is safe to send a patient home with."

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