Megan Kennelly, Andrew J Webb, Sophie E Ack, Gloria Hyunjung Kwak, Jonathan Rosand, Eric S Rosenthal
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引用次数: 0
Abstract
Background and objectives: 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.
Methods: 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.
Results: 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.
Discussion: 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.
背景和目的:未控制的高血压是心脏病发作、中风、痴呆和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,血压(BP)可能仅控制在就诊的30%-50%。考虑到资源密集型环境,住院是实现指导BP目标的理想选择。我们评估了神经危重症护理和住院期间的血压控制表现与出院时和随后2年内不受控制的高血压率之间的关系。方法:该双中心回顾性队列研究纳入了2016年4月至2022年12月期间入住神经科学重症监护病房(NeuroICU)的任何神经系统疾病的成年人,转至神经内科普通护理病房,然后出院回家或康复。高血压被定义为收缩压(SBP)≥140 mm Hg或舒张压(DBP)≥90 mm Hg。主要结局是出院时至出院后2年的高血压率。采用多变量logistic和广义加性模型来评估NeuroICU血压控制与持续性高血压之间的关系,调整基线共变量、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。结果: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。神经icu转移时收缩压每升高10毫米汞柱,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,转移时的高血压与出院时的高血压仍然独立相关(校正优势比3.85,95% CI 3.47-4.28)。这种关联在出院后24个月仍然存在,即使在没有高血压病史的患者、入院时血压正常的患者或调整抗高血压治疗强度的患者中也是如此。这种关联在一系列主要诊断和机构之间持续存在,尽管实践模式的变化在机构之间产生了显著差异。讨论:神经icu转移时的高血压与出院后2年未控制的高血压独立相关,与患者的诊断、病史、机构和治疗强度无关。初次住院是实现和维持指南指导的血压目标以减少继发性脑血管事件、痴呆和心血管并发症的机会。需要进一步的研究来确定神经icu转移和出院时血压控制率的提高是否会导致血压控制的长期改善。
期刊介绍:
Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.