PURPOSE: Studying the Treatment of Acute hyperTension (STAT) is a multicenter observational study of patients with acute severe hypertension (HTN) treated with IV antihypertensive therapy in critical care settings.
METHODS: Medical records were abstracted from patients treated between January 1 and December 31, 2007. Data were collected for 1599 patients from 25 hospitals.
RESULTS: The patients’ median age was 58 years, 49% were women, and 56% were black (vs 34% white). The median (Q1,Q3) qualifying BP was 200 mmHg (186,220) systolic and 110 (93, 123) diastolic. Most (88%) had a history of HTN, 35% had diabetes, 31% had chronic kidney disease, and 15% had a history of drug abuse. Medication non-compliance was a common (25%) predisposing factor. One quarter of patients had a prior hospitalization for severe HTN. The most common presenting symptoms were dyspnea (29%) and chest pain (26%). 77% had IV antihypertensive therapy begun in the emergency department. Presenting conditions and management are shown in the table. Median time to achieve a SBP <160 mmHg was 4.0 h, 61% had re-elevation to >=180 after initial control, and 5% developed iatrogenic hypotension (for patients with admitting diagnosis of subarachnoid hemorrhage, cutpoints of <140 and >=140 mmHg were used). 77% of patients had some degree of end-organ injury evident during hospitalization. Patients were discharged on a median of 2 antihypertensive drugs; 15% had no documentation of follow-up instructions or an appointment being scheduled, and 57% had no documented follow-up visit up to 90 days. Mortality at 90 days was 8.8%, 35% of patients were rehospitalized, one quarter of whom were rehospitalized for acute severe HTN.
CONCLUSION: STAT provides a contemporary view in a large, multicenter study of patients presenting with acute severe HTN. Our data show heterogeneity of management and blood pressure control and high short-term morbidity and mortality of this understudied condition.
CLINICAL IMPLICATIONS: There are significant opportunities for improvement in processes of care in the treatment of acute severe HTN.
DISCLOSURE: Joel Gore, No Financial Disclosure Information; No Product/Research Disclosure Information