Thursday, February 21, 2008

Acute hypertension patients don't receive enough follow-up
by Kelly Winget

A new registry study led by DCRI researchers found that many patients who have acute high blood pressure don't receive follow-up treatment, despite the high mortality rate associated with the condition.

The DCRI's Chris Granger, MD, lead author on the study, recently presented initial findings on the first multicenter study to review acute high blood pressure, also known as acute hypertension. One goal of the study is to identify how patients with the condition are managed, as Granger noted that acute hypertension has been understudied and there is limited understanding about the best way to treat the condition. The initial results were presented at the 37th Critical Care Congress of the Society of Clinical Care Medicine in February.

Acute hypertension is when a person has a blood pressure over 180/110 mm Hg. The recommended treatment is to give a patient an IV with antihypertensive drugs until the blood pressure returns to target levels. The study found little consistency in treatments patients received to lower their blood pressure and that acute hypertension is a major health concern in the U.S.

The STAT registry aims to collect data from up to 120 consecutive patients in each of 25 U.S. hospitals, with the goal of enrolling more than 1,500 patients. To date, almost 1,000 patients have been enrolled from 21 hospitals.

Lack of consistency in treatment and follow up

The initial findings indicate that acute hypertension is a widespread problem, with as many as 25 percent of patients in urban emergency departments in the southeastern U.S. having the condition. The findings also indicate that hypertension is not well managed by patients, as 90 percent of the patients had a history of hypertension and 25 percent did not routinely take their prescribed blood pressure medication.

Treatment for acute hypertension is also not consistent among hospitals. The initial findings indicate that a wide range of IV drugs are used to lower patients' blood pressure and some patients receive two or three different drugs. Getting the blood pressure to 160 mm Hg or below often took approximately four hours, and 4 percent of patients actually developed hypotension as a result of treatment, where their blood pressure dropped too low and required intervention. Even after doctors successfully lowered blood pressure to safe levels, 52 percent of patients had their systolic blood pressure return to 180 mm Hg or higher.

Patients with acute hypertension have a high rate of mortality. Initial findings show that 8 percent of the patients died within 90 days, and that 40 percent of patients were readmitted to the hospital within that same time frame. The mortality rate is the same as the rate for patients with acute coronary syndrome or acute heart failure, said Granger.

Despite the high mortality and re-hospitalization, 60 percent of the patients had no record of attending a follow-up appointment. The study will continue to collect and gather data on acute hypertension.