AJC: Hospitalizations for hypertension up, mortality down

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Hypertension cost the U.S. economy nearly $73 billion in 2009, according to the American Heart Association, and these numbers may only be getting worse, according to a study published in the Nov. 1 issue of the American Journal of Cardiology. The researchers reported that hospitalizations for hypertensive emergencies are on the rise, even after the Joint National Committee released recommendations to help better detect, prevent and evaluate high blood pressure.

“Approximately 1 percent to 2 percent of patients with hypertension will have a hypertensive emergency at some time in their life,” Abhishek Deshmukh, MD, of the Central Arkansas Veterans Healthcare System and Division of Cardiology at the University of Arkansas for Medical Sciences, Little Rock, Ark., and colleagues wrote. “However, no data are available on the frequency of hospitalizations for a hypertensive emergency after the publication of the Seventh Joint National Committee (JNC7) on the prevention, detection, evaluation and treatment of high blood pressure.”

Deshmukh et al set out to evaluate the changes in hospitalization frequency and in-hospital mortality for hypertensive emergencies prior to and post-JNC7 report. According to the JNC7 report, each 20 mm Hg increment in systolic blood pressure or 10 mm Hg increment in diastolic blood pressure doubles the risk of cardiovascular events. JNC offers several recommendations that can be instituted easily and help prevent hypertension.

The researchers used the Nationwide Inpatient Sample from 2000 to 2007, which included adult patients who were hospitalized with a diagnosis of a hypertensive emergency during the study period. In total, data on 456,259 hospitalizations were included.

The authors reported that the frequency of these hospitalizations increased in U.S. adults from 101 per 100,000 in 2000 to 111 per 100,000 in 2007, an average of about 10 percent. The absolute number of hypertension emergency hospitalizations increased from 49,018 to 61,043 per year during the follow-up period. While the authors reported that hospitalizations increased, all-cause in-hospital mortality rates decreased from 2.8 percent in the pre-JNC7 era to 2.6 percent in the post-JNC7 era.

The researchers found that more women than men were hospitalized for hypertensive emergencies during the study, 58.6 percent vs. 41.4 percent. Additionally, hospitalizations for white patients decreased while that of blacks increased during the study period.

As the rates of hospitalization for hypertensive emergencies increased, so did the mean total charges for a hospitalization increase--$15,434 in 2000 to $25,435 in 2007.

Despite the increases found during the study, the researchers said that the abundant number of antihypertensive drugs on the market has helped make treatment for these patients easier. “Significant adverse effects are uncommon with many of the drugs, and cost has become less of an issue with the availability of generic preparations for most antihypertensive drug classes,” the authors wrote.

Deshmukh et al said that most interesting was the decrease in hospitalizations and mortality between 2005 and 2007, because the JNC7 made recommendations regarding standardized and simple treatment of hypertension in 2003. “These recommendations were widely publicized to medical practitioners and, presumably, had the desired effect, because the number of patients with blood pressure control increased dramatically,” the authors wrote.

Blood pressure control is also affected by other factors, including access to healthcare, availability of health insurance, cost of therapy, medication adherence, adverse effects of drugs and the education of the patients. While all these factors contribute to blood pressure levels in patients, the authors said that more needs to be done to curb hospitalizations for hypertension and mortality.