Polgreen Linnea A, Suneja Manish, Tang Fan, Carter Barry L, Polgreen Philip M
From the Departments of Pharmacy Practice and Science (L.A.P., B.L.C.), Internal Medicine (M.S.), Biostatistics (F.T.), Internal Medicine and Epidemiology (P.M.P.), and Family Medicine (B.L.C.), University of Iowa.
Hypertension. 2015 May;65(5):1002-7. doi: 10.1161/HYPERTENSIONAHA.115.05241. Epub 2015 Mar 23.
Malignant hypertension and hypertensive encephalopathy are life-threating manifestations of hypertension. These syndromes primarily occur in patients with a history of poorly controlled hypertension. The purpose of this study was to investigate national trends in hospital admissions for malignant hypertension, hypertensive encephalopathy, and essential hypertension. This was a retrospective cohort study that used the Nationwide Inpatient Sample. We identified all hospitalizations between 2000 and 2011, during which a primary diagnosis of malignant hypertension (ICD 9 code: 401.0), hypertensive encephalopathy (ICD 9 code: 437.2), or essential hypertension (ICD 9 code: 401.9) was recorded. Time series models were estimated for malignant hypertension, hypertensive encephalopathy, essential hypertension and also for the combined series. A piecewise linear regression analyses was performed to investigate whether there were changes in the trends of these series. In addition, we also compared the characteristics of patients with these diagnoses. The estimated number of admissions for both malignant hypertension and hypertensive encephalopathy increased dramatically after 2007, whereas discharges for essential hypertension fell, and there was no change in trend for the combined series. Costs rose substantially for patients with these diagnoses after 2007, but mortality significantly fell for malignant hypertension and mortality for hypertensive encephalopathy did not change. The dramatic increase in the number of hospital admissions for hypertensive encephalopathy and malignant hypertension should have resulted in dramatic increases in morbidity, but it did not. The change is most likely related to changes in coding related to diagnostic-related groups that occurred in 2007.
恶性高血压和高血压脑病是高血压的危及生命的表现。这些综合征主要发生在高血压控制不佳病史的患者中。本研究的目的是调查恶性高血压、高血压脑病和原发性高血压的全国住院趋势。这是一项使用全国住院患者样本的回顾性队列研究。我们确定了2000年至2011年期间所有住院病例，在此期间记录了恶性高血压（ICD-9编码：401.0）、高血压脑病（ICD-9编码：437.2）或原发性高血压（ICD-9编码：401.9）的初步诊断。对恶性高血压、高血压脑病、原发性高血压以及合并系列进行了时间序列模型估计。进行了分段线性回归分析，以研究这些系列趋势是否存在变化。此外，我们还比较了这些诊断患者的特征。2007年后，恶性高血压和高血压脑病的估计入院人数均大幅增加，而原发性高血压的出院人数下降，合并系列的趋势没有变化。2007年后，这些诊断患者的费用大幅上升，但恶性高血压的死亡率显著下降，高血压脑病的死亡率没有变化。高血压脑病和恶性高血压住院人数的急剧增加本应导致发病率大幅上升，但实际并非如此。这种变化很可能与2007年发生的与诊断相关组编码变化有关。
