Elzanaty Ahmed M, Saeyeldin Ayman, Royfman Rachel, Maraey Ahmed, Khalil Mahmoud, Aboul-Nour Hassan, Elsheikh Eman, Meenakshisundaram Chandramohan, Siragy Helmy M, Grubb Blair
Division of Cardiovascular Medicine, University of Toledo, Toledo, OH.
Department of internal medicine, Saint Mary's hospital, Waterbury, CT; Department of Advanced heart failure and transplant, Baylor university medical center, Dallas, TX.
Curr Probl Cardiol. 2023 Feb;48(2):101455. doi: 10.1016/j.cpcardiol.2022.101455. Epub 2022 Oct 22.
Supine hypertension-orthostatic hypotension disease poses a management challenge to clinicians. Data on short term outcomes of patients with orthostatic hypotension (OH) who are hospitalized with hypertensive (HTN) crises is lacking. The Nationwide Readmission Database 2016-2019 was queried for all hospitalizations of HTN crises. Hospitalizations were stratified according to whether OH was present or not. We employed propensity score to match hospitalizations for patients with OH to those without, at 1:1 ratio. Outcomes evaluated were 30-days readmission with HTN crises or falls, as well as hospital outcomes of in-hospital mortality, acute kidney injury, acute congestive heart failure, acute coronary syndrome, type 2 myocardial infarction, aortic dissection, stroke, length of stay (LOS), discharge to nursing home and hospitalization costs. We included a total of 9451 hospitalization (4735 in the OH group vs 4716 in the control group). OH group was more likely to be readmitted with falls (Odds ratio [OR]:3.27, P < 0.01) but not with HTN crises (P = 0.05). Both groups had similar likelihood of developing acute kidney injury (P = 0.08), stroke/transient ischemic attack (P = 0.52), and aortic dissection (P = 0.66). Alternatively, OH group were less likely to develop acute heart failure (OR:0.54, P < 0.01) or acute coronary syndrome (OR:0.39, P < 0.01) in the setting of HTN crises than non-OH group. OH group were more likely to have longer LOS and have higher hospitalization costs. Patients with OH who are admitted with HTN crises tend to have similar or lower HTN-related complications to non-OH group while having higher likelihood of readmission with falls, LOS and hospitalization costs. Further studies are needed to confirm such findings.
仰卧位高血压-直立性低血压疾病给临床医生带来了管理挑战。缺乏关于因高血压危象住院的直立性低血压（OH）患者短期预后的数据。我们查询了2016 - 2019年全国再入院数据库中所有高血压危象的住院病例。根据是否存在OH对住院病例进行分层。我们采用倾向评分法，以1:1的比例将OH患者的住院病例与非OH患者的住院病例进行匹配。评估的结局包括30天内因高血压危象或跌倒再次入院，以及院内死亡率、急性肾损伤、急性充血性心力衰竭、急性冠状动脉综合征、2型心肌梗死、主动脉夹层、中风、住院时间（LOS）、出院至养老院情况和住院费用等医院结局。我们共纳入了9451例住院病例（OH组4735例，对照组4716例）。OH组因跌倒再次入院的可能性更高（优势比[OR]：3.27，P < 0.01），但因高血压危象再次入院的可能性无差异（P = 0.05）。两组发生急性肾损伤（P = 0.08）、中风/短暂性脑缺血发作（P = 0.52）和主动脉夹层（P = 0.66）的可能性相似。相比之下，在高血压危象情况下，OH组发生急性心力衰竭（OR：0.54，P < 0.01）或急性冠状动脉综合征（OR：0.39，P < 0.01）的可能性低于非OH组。OH组的住院时间往往更长，住院费用更高。因高血压危象入院的OH患者与非OH组相比，高血压相关并发症往往相似或更低，但因跌倒再次入院、住院时间和住院费用的可能性更高。需要进一步研究来证实这些发现。
