Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.).
Department of Nephrology and Hypertension, Dokkyo Medical University, Shimotsuga, Tochigi, Japan (T.R.).
Hypertension. 2023 Dec;80(12):2591-2600. doi: 10.1161/HYPERTENSIONAHA.123.21880. Epub 2023 Oct 11.
Despite increasing incidences of hypertension, recent trends in mortality and urgent dialysis following acute hypertension (AHT) remain undetermined.
This retrospective observational cohort study evaluated 50 316 hospitalized AHT patients from 2010 to 2019, using an administrative claims database in Japan. We examined trends in incidence, urgent dialysis, mortality, and its risk factors using Poisson regression models. Using codes, AHT was categorized into 5 spectrums: malignant hypertension (=1792), hypertensive emergency (=17 907), hypertensive urgency (=1562), hypertensive encephalopathy (=6593), and hypertensive heart failure (HHF; =22 462).
The median age of the patients was 76 years, and 54.9% were women. The total AHT incidence was 70 cases per 100 000 admission year. The absolute death rate increased from 1.83% (95% CI, 1.40-2.40) to 2.88% ([95% CI, 2.42-3.41]; Cochran-Armitage trend test, 0.0001). Upward trends were observed in patients aged ≥80, with lean body mass index ≤18.4, and with HHF. Urgent dialysis rates increased from 1.52% (95% CI, 1.12-2.06) to 2.60% (2.17-3.1; Cochran-Armitage trend test; =0.0071) in 48 235 patients, excluding maintenance dialysis patients. Older age, men, lean body mass, malignant hypertension, HHF, and underlying chronic kidney disease correlated with higher mortality risk; greater hospital volume correlated with lower mortality risk; and malignant hypertension, HHF, diabetes, chronic kidney disease, and scleroderma correlated with a higher risk of urgent dialysis.
Mortality and urgent dialysis rates following AHT have increased. Aging, complex comorbidities, and HHF-type AHT contributed to the rising trend of mortality.
尽管高血压发病率不断上升，但急性高血压（AHT）后死亡率和紧急透析的近期趋势仍未确定。
本回顾性观察性队列研究使用日本行政索赔数据库评估了 2010 年至 2019 年间 50316 例住院 AHT 患者。我们使用泊松回归模型检查了发病率、紧急透析、死亡率及其危险因素的趋势。使用 ICD-10 代码，将 AHT 分为 5 个谱：恶性高血压（=1792）、高血压急症（=17907）、高血压亚急症（=1562）、高血压脑病（=6593）和高血压性心力衰竭（HHF；=22462）。
患者的中位年龄为 76 岁，54.9%为女性。AHT 的总发病率为每 100000 个入院年 70 例。绝对死亡率从 1.83%（95%置信区间，1.40-2.40）增加到 2.88%（95%置信区间，2.42-3.41）（Cochran-Armitage 趋势检验，0.0001）。≥80 岁、瘦体重指数≤18.4 和 HHF 的患者呈上升趋势。在排除维持性透析患者的 48235 例患者中，紧急透析率从 1.52%（95%置信区间，1.12-2.06）增加到 2.60%（2.17-3.1；Cochran-Armitage 趋势检验；=0.0071）。年龄较大、男性、瘦体重、恶性高血压、HHF 和基础慢性肾脏病与更高的死亡率风险相关；医院容量较大与死亡率较低相关；恶性高血压、HHF、糖尿病、慢性肾脏病和硬皮病与紧急透析的风险增加相关。
AHT 后死亡率和紧急透析率有所增加。老龄化、复杂合并症和 HHF 型 AHT 导致死亡率呈上升趋势。
