Key result
Among hospitalized hypertensive patients, elevated emergency department systolic blood pressure (140-159 mm Hg) was associated with lower in-hospital mortality (OR 0.7) compared to normal systolic blood pressure (110-139 mm Hg).
Why the study?
Blood pressure is commonly elevated in the ED, especially among hypertensive patients, but the association between ED systolic blood pressure and in-hospital mortality among these patients was unclear.
Is normal systolic blood pressure in the emergency department associated with higher in-hospital mortality compared to elevated systolic blood pressure among hospitalized hypertensive patients?
Cohort (n=96,423)
No
Is normal systolic blood pressure in the emergency department associated with higher in-hospital mortality compared to elevated systolic blood pressure among hospitalized hypertensive patients?
Odds Ratio: 0.7 (95% CI 0.6–0.7)
Absolute Event Rate: 2.9% vs 4.9%
p-value: p=<0.001
Among hospitalized hypertensive patients, a 'normal' emergency department systolic blood pressure of 110-139 mm Hg is paradoxically associated with higher in-hospital mortality compared to elevated SBP up to 200 mm Hg.
May warrant closer monitoring of normotensive-range ED BP in hypertensive inpatients; hypothesis-generating and requires prospective confirmation.
Blood pressure is commonly elevated at the hospital emergency department (ED), especially among hypertensive patients. The aim of the study was to determine the association between ED systolic blood pressure (SBP) and in-hospital mortality among hypertensive patients. The authors retrospectively retrieved records of hypertensive patients who were hospitalized during a seven-year period. The authors examined the association between SBP and in-hospital mortality rate, adjusted for demographics, heart rate, comorbidities, laboratory results, and hospital ward. Overall, 96 423 patients were included. Compared to patients with SBP 110-139 mm Hg, the adjusted odds ratios were 4.1 (95% CI, 3.7-4.6) with SBP <90, 1.6 (95% CI, 1.4-1.7) with SBP 90-109, 0.7 (95% CI, 0.6-0.7) with SBP 140-159, 0.7 (95% CI, 0.6-0.7) with SBP 160-179, 0.7 (95% CI, 0.6-0.8) with SBP 180-199, 0.9 (95% CI, 0.7-1.1) with SBP 200-219, and 1.1 (95% CI, 0.7-1.7) with SBP ≥220 mm Hg. Thus, SBP levels of 110-139 mm Hg were associated with higher in-hospital mortality in comparison with elevated SBP up to 200 mm Hg.
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Klang et al. (2019) conducted a cohort in Hypertension (n=96,423). Elevated systolic blood pressure (140-159 mm Hg) vs. Normal systolic blood pressure (110-139 mm Hg) was evaluated on In-hospital mortality (OR 0.7, 95% CI 0.6-0.7, p=<0.001). Among hospitalized hypertensive patients, elevated emergency department systolic blood pressure (140-159 mm Hg) was associated with lower in-hospital mortality (OR 0.7) compared to normal systolic blood pressure (110-139 mm Hg).
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