Elzanaty AM, Saeyeldin A, Royfman R, Maraey A, Khalil M, Aboulnour H, Elsheikh E, Meenakshisundaram C, Siragy HM, and Grubb B. Short-term Outcomes of Hypertensive Crises in Patients with Orthostatic Hypotension. Curr Probl Cardiol 2022; 101455.
Current problems in cardiology
INTRODUCTION: Supine hypertension-orthostatic hypotension disease (SH-OH) poses a management challenge to clinicians. Data on short term outcomes of patients with OH who are hospitalized with hypertensive (HTN) crises is lacking
METHODS: The Nationwide Readmission Database 2016-2019 was queried for all hospitalizations of HTN crises. Hospitalizations were stratified according to whether OH was present or not. We employed propensity score to match hospitalizations for patients with OH to those without, at 1:1 ratio. Outcomes evaluated were 30-days readmission with HTN crises or falls, as well as hospital outcomes of in-hospital mortality, acute kidney injury (AKI), acute congestive heart failure (CHF), acute coronary syndrome (ACS), type 2 myocardial infarction (T2MI), aortic dissection, stroke, length of stay (LOS), discharge to nursing home and hospitalization costs.
RESULTS: We included a total of 9,451 hospitalization (4,735 in the OH group vs 4,716 in the control group). OH group was more likely to be readmitted with falls (Odds ratio [OR]:3.27, p<0.01) but not with HTN crises(p=0.05). Both groups had similar likelihood of developing AKI (p=0.08), stroke/TIA (p=0.52), and aortic dissection(p=0.66). Alternatively, OH group were less likely to develop acute HF (OR:0.54, p<0.01) or ACS (OR:0.39, p<0.01) in the setting of HTN crises than non-OH group. OH group were more likely to have longer LOS and have higher hospitalization costs.
CONCLUSION: Patients with OH who are admitted with HTN crises tend to have similar or lower HTN-related complications to non-OH group while having higher likelihood of readmission with falls, LOS and hospitalization costs. Further studies are needed to confirm such findings.
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