Key result
Systolic blood pressure in hospitalized patients increases with age, with 9.7% of younger women meeting the sepsis criterion of systolic <100 mm Hg at discharge compared to 2.3% of younger men.
Why the study?
Guidelines for identifying physiological deterioration and sepsis use blood pressure thresholds that do not account for age or sex, and whether non-hospital differences remain in hospitalized patients is unknown.
Cross-Sectional (n=75,342)
Yes
Answers are grounded in this paper and cite their sources.
Significant age and sex variations exist in the blood pressure of hospitalized patients, indicating that fixed thresholds for identifying physiological deterioration or sepsis may disproportionately misclassify certain groups, such as younger women.
OBJECTIVES: National guidelines for identifying physiological deterioration and sepsis in hospitals depend on thresholds for blood pressure that do not account for age or sex. In populations outside hospital, differences in blood pressure are known to occur with both variables. Whether these differences remain in the hospitalised population is unknown. This database analysis study aims to generate representative centiles to quantify variations in blood pressure by age and sex in hospitalised patients. DESIGN: Retrospective cross-sectional observational database analysis. SETTING: Four near-sea-level hospitals between April 2015 and April 2017 PARTICIPANTS: 75 342 adult patients who were admitted to the hospitals and had at least one set of documented vital sign observations within 24 hours before discharge were eligible for inclusion. Patients were excluded if they died in hospital, had no vital signs 24 hours prior to discharge, were readmitted within 7 days of discharge, had missing age or sex or had no blood pressure recorded. RESULTS: Systolic blood pressure (SBP) for hospitalised patients increases with age for both sexes. Median SBP increases from 122 (CI: 121.1 to 122.1) mm Hg to 132 (CI: 130.9 to 132.2) mm Hg in men, and 114 (CI: 113.1 to 114.4) mm Hg to 135 (CI: 134.5 to 136.2) mm Hg in women, between the ages of 20 and 90 years. Diastolic blood pressure peaked around 50 years for men 76 (CI: 75.5 to 75.9) mm Hg and women 69 (CI: 69.0 to 69.4) mm Hg. The blood pressure criterion for sepsis, systolic <100 mm Hg, was met by 2.3% of younger (20-30 years) men and 3.5% of older men (81-90 years). In comparison, the criterion was met by 9.7% of younger women and 2.6% of older women. CONCLUSION: We have quantified variations in blood pressure by age and sex in hospitalised patients that have implications for recognition of deterioration. Nearly 10% of younger women met the blood pressure criterion for sepsis at hospital discharge.
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Wong et al. (2020) conducted a cross-sectional in Hospitalised patients (n=75,342). Age and sex was evaluated on Blood pressure variations by age and sex. Systolic blood pressure in hospitalized patients increases with age, with 9.7% of younger women meeting the sepsis criterion of systolic <100 mm Hg at discharge compared to 2.3% of younger men.
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