Katz Jason N, Gore Joel M, Amin Alpesh, Anderson Frederick A, Dasta Joseph F, Ferguson James J, Kleinschmidt Kurt, Mayer Stephan A, Multz Alan S, Peacock W Frank, Peterson Eric, Pollack Charles, Sung Gene Yong, Shorr Andrew, Varon Joseph, Wyman Allison, Emery Leigh A, Granger Christopher B
Duke Clinical Research Institute, Durham, NC 27705, USA.
Am Heart J. 2009 Oct;158(4):599-606.e1. doi: 10.1016/j.ahj.2009.07.020.
Limited data are available on the care of patients with acute severe hypertension requiring hospitalization. We characterized contemporary practice patterns and outcomes for this population.
STAT is a 25-institution, US registry of consecutive patients with acute severe hypertension (>180 mm Hg systolic and/or >110 mm Hg diastolic; >140 and/or >90 for subarachnoid hemorrhage) treated with intravenous therapy in a critical care setting.
One thousand five hundred eighty-eight patients were enrolled (January 2007 to April 2008). Median age was 58 years (interquartile range 49-70 years), 779 (49%) were women, and 892 (56%) were African American; 27% (n = 425) had a prior admission for acute hypertension and 486 (31%) had chronic kidney disease. Median qualifying blood pressure (BP) was 200 (186, 220) systolic and 110 (93, 123) mm Hg diastolic. Initial intravenous antihypertensive therapies used to control BP varied, with 1,009 (64%) patients requiring multiple drugs. Median time to achieve a systolic BP <160 mm Hg (<140 mm Hg for subarachnoid hemorrhage) was 4.0 (0.8, 12) hours; 893 (60%) had reelevation to >180 (>140 for subarachnoid hemorrhage) after initial control; and 63 (4.0%) developed iatrogenic hypotension. Hospital mortality was 6.9% (n = 109) with an aggregate 90-day mortality rate of 11% (174/1,588); 59% (n = 943) had acute/worsening end-organ dysfunction during hospitalization. The 90-day readmission rate was 37% (523/1,415), of which one quarter (132/523) was due to recurrent acute severe hypertension.
This study highlights heterogeneity in care, BP control, and outcomes of patients hospitalized with acute severe hypertension.
关于需要住院治疗的急性重症高血压患者的护理数据有限。我们对这一人群的当代治疗模式和结局进行了描述。
STAT是一项在美国25家机构开展的登记研究，纳入在重症监护环境中接受静脉治疗的连续性急性重症高血压患者（收缩压>180 mmHg和/或舒张压>110 mmHg；蛛网膜下腔出血患者收缩压>140 mmHg和/或舒张压>90 mmHg）。
共纳入1588例患者（2007年1月至2008年4月）。中位年龄为58岁（四分位间距49 - 70岁），779例（49%）为女性，892例（56%）为非裔美国人；27%（n = 425）曾因急性高血压入院，486例（31%）患有慢性肾脏病。中位合格血压（BP）为收缩压200（186，220）mmHg和舒张压110（93，123）mmHg。用于控制血压的初始静脉降压治疗方法各异，1009例（64%）患者需要多种药物。收缩压降至<160 mmHg（蛛网膜下腔出血患者为<140 mmHg）的中位时间为4.0（0.8，12）小时；893例（60%）在初始控制后血压再次升高至>180 mmHg（蛛网膜下腔出血患者为>140 mmHg）；63例（4.0%）发生医源性低血压。医院死亡率为6.9%（n = 109），90天总死亡率为11%（174/1588）；59%（n = 943）患者在住院期间出现急性/加重的终末器官功能障碍。90天再入院率为37%（523/1415），其中四分之一（132/523）是由于复发性急性重症高血压。
本研究突出了急性重症高血压住院患者在护理、血压控制和结局方面的异质性。
