Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Abstract

BackgroundThe incidence of hypertensive emergency in US emergency departments (ED) is not well established.Methods and ResultsThis study is a descriptive epidemiological analysis of nationally representative ED visit‐level data from the Nationwide Emergency Department Sample for 2006–2013. Nationwide Emergency Department Sample is a publicly available database maintained by the Healthcare Cost and Utilization Project. An ED visit was considered to be a hypertensive emergency if it met all the following criteria: diagnosis of acute hypertension, at least 1 diagnosis indicating acute target organ damage, and qualifying disposition (admission to the hospital, death, or transfer to another facility). The incidence of adult ED visits for acute hypertension increased monotonically in the period from 2006 through 2013, from 170 340 (1820 per million adult ED visits overall) to 496 894 (4610 per million). Hypertensive emergency was rare overall, accounting for 63 406 visits (677 per million adult ED visits overall) in 2006 to 176 769 visits (1670 per million) in 2013. Among adult ED visits that had any diagnosis of hypertension, hypertensive emergency accounted for 3309 per million in 2006 and 6178 per million in 2013.ConclusionsThe estimated number of visits for hypertensive emergency and the rate per million adult ED visits has more than doubled from 2006 to 2013. However, hypertensive emergencies are rare overall, occurring in about 2 in 1000 adult ED visits overall, and 6 in 1000 adult ED visits carrying any diagnosis of hypertension in 2013. This figure is far lower than what has been sometimes cited in previous literature.

Hospital and out‐of‐hospital mortality in 670 hypertensive emergencies and urgencies

“…Sample of the United States showed that the incidence of adult emergency department visits for acute hypertension increased monotonically in 2006 to 2013 from 170 340 to 496 894. 6 Hypertensive emergencies accounted for 63 406 visits (677 per million adult emergency department visits overall) in 2006 and 176 769 visits (1670 per million) in 2013. A large American cohort of 1588 consecutive patients with acute severe hypertension from the STAT registry was analyzed in 2009.…”

“…Epidemiological and clinical characteristics of hypertensive emergencies and urgencies have been described in the literature. A recent report from the Nationwide Emergency Department Sample of the United States showed that the incidence of adult emergency department visits for acute hypertension increased monotonically in 2006 to 2013 from 170 340 to 496 894 . Hypertensive emergencies accounted for 63 406 visits (677 per million adult emergency department visits overall) in 2006 and 176 769 visits (1670 per million) in 2013.…”

Exploring racial/ethnic disparities in hypertension care among patients served by health centers in the United States

“…For example, hypertension consistently ranks as one of the primary reasons to visit a doctor . Hypertension‐related emergency department (ED) visits are also rising, and patients with hypertension have longer hospital stays and incur greater costs …”

“…8 Hypertension-related emergency department (ED) visits are also rising, and patients with hypertension have longer hospital stays and incur greater costs. 9,10 Hypertension takes on further national significance as its burden and impact is unequally distributed across the nation's populations. 11,12 Racial and ethnic minorities, particularly African Americans, have higher rates of hypertension morbidity and mortality Some racial/ethnic minorities are more likely to have hypertension and experience increased hypertension-related morbidity and mortality compared to whites.…”

Direct assessment of adherence and drug interactions in patients with hypertensive crisis—A cross‐sectional study in the Emergency Department

“…In 15 of these 62 patients (24%), a nonadherence could be demonstrated, and in 21 patients (34%), a partial nonadherence could be demonstrated. Patients with nonadherence or partial nonadherence showed a longer hypertension history (15 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs 10 [3][4][5][6][7][8][9][10][11][12][13][14][15] years, P = 0.04) were prescribed more general medication (number 7.1 ± 3.4 vs 3.4 ± 1.8; P < 0.01) as well as antihypertensive drugs (number 2.8 ± 1.1 vs 1.5 ± 0.7, P < 0.01). A potential BP-raising trigger by medications or food interaction was frequently detectable, predominantly with nonsteroidal anti-inflammatory drugs (NSAIDs; n = 38), glucocorticoids (n = 8), antidepressants (n = 10), and licorice (n = 10).…”