Obesity (body mass index ≥ 30 kg/m2) was associated with a lower risk of myocardial injury (OR 0.50) compared to non-obese patients presenting with hypertensive crisis, demonstrating an obesity paradox.
Cohort (n=467)
No
Among patients with hypertensive crisis, lower BMI, prior heart failure, and aspirin use are associated with higher odds of myocardial injury, highlighting an 'obesity paradox' in this population.
Effect estimate: OR 0.50 (95% CI 0.28-0.89)
p-value: p=0.018
Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) 99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
Acosta et al. (Mon,) conducted a cohort in Hypertensive crisis (n=467). Body mass index ≥ 30 kg/m2 vs. Body mass index < 30 kg/m2 was evaluated on Myocardial injury (troponin >99th percentile of URL) (OR 0.50, 95% CI 0.28-0.89, p=0.018). Obesity (body mass index ≥ 30 kg/m2) was associated with a lower risk of myocardial injury (OR 0.50) compared to non-obese patients presenting with hypertensive crisis, demonstrating an obesity paradox.