Hospitalizations for Hypertension Increasing in the US

Joseph Ebinger, MD

A recent analysis from a nationally representative sample of patients details a concerning rise in the number of people hospitalized for a hypertensive crisis.

An analysis of the National Inpatient Sample (NIS) by investigators at the Smidt Heart Institute at Cedars-Sinai, results suggest the number of annual hospitalizations across the US for hypertensive crises more than doubled during the 13-year study period.

“Although more people have been able to manage their blood pressure over the last few years, we’re not seeing this improvement translate into fewer hospitalizations for hypertensive crisis,” said lead investigator Joseph E. Ebinger, MD, a clinical cardiologist and director of clinical analytics at the Smidt Heart Institute, in a statement.

The progress made in the fight against cardiovascular disease in the US is regarded as one of the greatest public health efforts in history. Although the progress has been immense, estimates suggest hypertension is still a major contributor to excess mortality. With this in mind, Ebinger and a team of colleagues from Cedars-Sinai to better understand longitudinal changes in hypertension control overall among the US population.

To do so, the study was designed as an analysis of the NIS to assess sex-pooled and sex-specific trends in hypertensive crisis hospitalizations and fatalities rates from 2002-2014. For the purpose of analysis, investigators sought to assess trends over serial time periods defined as 2002-2006, 2007-2011, and 2012-2014.

Multivariable logistic regression models were used to estimate trends in odds of hospitalization and death related to malignant hypertension over time using the SURVEYLOGISTIC procedure in SAS. Covariates included in the analyses included age, race or ethnicity, obesity, hypercholesterolemia, diabetes, and preexisting cardiovascular conditions.

From 2002-2014, investigators identified 918,392±9331 hospitalizations and 4377±157 in-hospital deaths related to hypertensive crisis across the US. Investigators pointed out hypertensive crises represented 0.23±0.002% of all hospitalizations during the study period. The mean age of patients hospitalized for hypertensive crisis was 60.2±0.1 years, 58.5±0.1% were women, and most patients identified as either non-Hispanic White (39.4±0.4%) or non-Hispanic Black (34.3±0.4%).

Among the cohort of patients who died in hospital, the mean age was 68.1±0.6 years, 60.0±1.6% were women, and most patients identified as either non-Hispanic White (43.4±1.7%) or non-Hispanic Black (31.0±1.7%). Among these patients, 80.4±1.3% had at least 1 cardiovascular condition, including 46.8±1.7% with renal failure, 16.9±1.3% with myocardial infarction, 43.9±1.7% with heart failure, and 29.2±1.5% with cerebrovascular disease.

In adjusted analyses, results indicated the odds of experiencing a hospitalization for hypertensive crisis increased annually for men (OR, 1.083 per year [95% CI, 1.08-1.09]) and women (OR, 1.07 per year [95% CI, 1.07-1.08]), with a higher rate of increase seen in men compared with their female counterparts (P <.001). However, results also indicated the adjusted odds of death during hospitalization for a hypertensive crisis decreased annually, with the rate of decline similar for men (OR, 0.89 per year [95% CI, 0.86-0.92]) and women (OR, 0.92 per year [95% CI, 0.90-0.94]).

“These findings raise the question: Are there sex-specific biologic mechanisms that place women at greater risk for dying during a hypertensive crisis?” said senior investigator Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute, in the aforementioned statement. “By understanding these processes, we could prevent more deaths among women."

This study, “Sex‐Specific Temporal Trends in Hypertensive Crisis Hospitalizations in the United States,” was published in the Journal of American Heart Association.