In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 8 ( 2021-8-17), p. e0251311-
Abstract:
Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0251311
DOI:
10.1371/journal.pone.0251311.g001
DOI:
10.1371/journal.pone.0251311.g002
DOI:
10.1371/journal.pone.0251311.g003
DOI:
10.1371/journal.pone.0251311.g004
DOI:
10.1371/journal.pone.0251311.t001
DOI:
10.1371/journal.pone.0251311.t002
DOI:
10.1371/journal.pone.0251311.s001
DOI:
10.1371/journal.pone.0251311.s002
DOI:
10.1371/journal.pone.0251311.s003
DOI:
10.1371/journal.pone.0251311.s004
DOI:
10.1371/journal.pone.0251311.s005
DOI:
10.1371/journal.pone.0251311.s006
DOI:
10.1371/journal.pone.0251311.s007
DOI:
10.1371/journal.pone.0251311.s008
DOI:
10.1371/journal.pone.0251311.s009
DOI:
10.1371/journal.pone.0251311.s010
DOI:
10.1371/journal.pone.0251311.s011
DOI:
10.1371/journal.pone.0251311.r001
DOI:
10.1371/journal.pone.0251311.r002
DOI:
10.1371/journal.pone.0251311.r003
DOI:
10.1371/journal.pone.0251311.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
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