Kennelly Megan, Webb Andrew J, Ack Sophie E, Kwak Gloria Hyunjung, Rosand Jonathan, Rosenthal Eric S
Department of Neurology, Mass General Brigham, Boston.
Department of Pharmacy, Massachusetts General Hospital, Boston; and.
Neurol Clin Pract. 2025 Apr;15(2):e200453. doi: 10.1212/CPJ.0000000000200453. Epub 2025 Mar 20.
Uncontrolled hypertension is a risk factor of heart attack, stroke, dementia, and other conditions. In outpatients with hypertension, blood pressure (BP) may be controlled at only 30%-50% of visits depending on the population studied. Hospital admission is ideal for achieving guideline-directed BP targets, given the resource-intensive environment. We evaluated the relationship between BP control performance during neurocritical care and hospital admission and rates of uncontrolled hypertension at discharge and over the subsequent 2 years.
This two-center retrospective cohort included adults admitted with any neurologic illness to an neurosciences intensive care unit (NeuroICU) from April 2016 to December 2022, transferred to a neurology general care unit, and then discharged to home or rehabilitation. Hypertension was defined as systolic BP (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg. The primary outcomes were rates of hypertension at hospital discharge through 2 years after discharge. Multivariable logistic and generalized additive models were developed to assess the association between NeuroICU BP control and persistent hypertension, adjusting for baseline covariates, NeuroICU length of stay, performance measures quantifying BP goals, and antihypertensive medication intensity on transferring from the NeuroICU.
Of 13,711 admissions, 10,836 met inclusion criteria and 3,075 (28.3%) were hypertensive at hospital discharge. Each 10-mm Hg SBP increase at NeuroICU transfer was associated with 1.60-fold increased odds of uncontrolled hypertension at discharge (95% CI 1.56-1.64). In multivariate analysis controlling for covariates, hypertension at transfer remained independently associated with hypertension at discharge (adjusted odds ratio 3.85, 95% CI 3.47-4.28). The association persisted through 24 months after discharge, even among those without a history of hypertension, among those admitted to the hospital normotensive, or when adjusting for antihypertensive therapy intensity. The association persisted across a range of principal diagnoses and across institutions, although practice-pattern variation yielded significant differences between institutions.
Hypertension at NeuroICU transfer was independently associated with uncontrolled hypertension through hospital discharge and the subsequent 2 years, independent of patient diagnosis, medical history, institution, and treatment intensity. The initial hospitalization represents an opportunity to achieve and maintain guideline-directed BP targets to reduce secondary cerebrovascular events, dementia, and cardiovascular complications. Further studies are needed to determine whether improving rates of BP control at NeuroICU transfer and discharge leads to long-term improvements in BP control.
未控制的高血压是心脏病发作、中风、痴呆及其他疾病的危险因素。在高血压门诊患者中，根据所研究的人群不同，血压（BP）在仅30%-50%的就诊时得以控制。鉴于资源密集型环境，住院治疗是实现指南指导的血压目标的理想方式。我们评估了神经重症监护期间及住院期间的血压控制表现与出院时及随后2年未控制高血压发生率之间的关系。
这项双中心回顾性队列研究纳入了2016年4月至2022年12月期间因任何神经系统疾病入住神经科学重症监护病房（NeuroICU）、随后转入神经内科普通护理病房、然后出院回家或接受康复治疗的成年人。高血压定义为收缩压（SBP）≥140 mmHg或舒张压（DBP）≥90 mmHg。主要结局是出院后至出院后2年的高血压发生率。建立多变量逻辑回归模型和广义相加模型，以评估NeuroICU血压控制与持续性高血压之间的关联，并对基线协变量、NeuroICU住院时间、量化血压目标的绩效指标以及从NeuroICU转出时的降压药物强度进行调整。
在13711例入院患者中，10836例符合纳入标准，3075例（28.3%）出院时患有高血压。在NeuroICU转出时，收缩压每升高10 mmHg，出院时未控制高血压的几率增加1.60倍（95%CI 1.56-1.64）。在控制协变量的多变量分析中，转出时的高血压与出院时的高血压仍独立相关（调整后的优势比为3.85，95%CI 3.47-4.28）。这种关联在出院后24个月内持续存在，即使在无高血压病史者、入院时血压正常者中，或在调整降压治疗强度时也是如此。尽管机构间的实践模式存在差异，但在一系列主要诊断中以及不同机构间，这种关联均持续存在。
NeuroICU转出时的高血压与出院时及随后2年未控制的高血压独立相关，与患者诊断、病史、机构及治疗强度无关。首次住院是实现并维持指南指导的血压目标以减少继发性脑血管事件、痴呆及心血管并发症的一个机会。需要进一步研究以确定改善NeuroICU转出时及出院时的血压控制率是否会带来血压控制的长期改善。
