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Characteristics, practice patterns, and outcomes in patients with acute hypertension: European registry for Studying the Treatment of Acute hyperTension (Euro-STAT)

Alain Vuylsteke1*, Jean-Louis Vincent2, Didier Payen de La Garanderie3, Frederick A Anderson4, Leigh Emery5, Allison Wyman4, Sophie Rushton-Smith4, Joel M Gore4 and the Euro-STAT Investigators

Author Affiliations

1 Department of Anaesthesia & Intensive Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

2 Department of Intensive Care, Erasme University Hospital, Route de Lennik 808 1070, University of Brussels, Brussels, Belgium

3 l'hôpital Lariboisière, 2 Rue Ambroise Paré, 75475 Paris Cedex 10 Assistance publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot-Paris 7, Paris, France

4 Center for Outcomes Research, University of Massachusetts Medical School, One Innovation Drive, Suite 110 Worcester, MA 01605 USA

5 Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA

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Critical Care 2011, 15:R271  doi:10.1186/cc10551

Published: 16 November 2011

Abstract

Introduction

Although effective strategies are available for the management of chronic hypertension, less is known about treating patients with acute, severe elevations in blood pressure. Using data from the European registry for Studying the Treatment of Acute hyperTension (Euro-STAT), we sought to evaluate 'real-life' management practices and outcomes in patients who received intravenous antihypertensive therapy to treat an episode of acute hypertension.

Methods

Euro-STAT is a European, hospital-based, observational study of consecutive adult patients treated with intravenous antihypertensive therapy while in the emergency department, perioperative unit or ICU. Enrolment took place between 1 July and 15 October 2009 in 11 hospitals in 7 European countries (Austria, Belgium, Germany, Italy, Spain, Sweden and the United Kingdom).

Results

The study population was composed of 791 consecutive patients (median age 69 years, 37% women). Median arterial blood pressure before treatment was 166 mmHg systolic blood pressure (IQR 141 to 190 mmHg) and 80 mmHg diastolic blood pressure (IQR 68 to 95). Nitroglycerine was the most commonly used antihypertensive treatment overall (40% of patients), followed by urapidil (21%), clonidine (16%) and furosemide (8%). Treatment was associated with hypotension in almost 10% of patients. Overall 30-day mortality was 4%, and new or worsening end-organ damage occurred in 19% of patients.

Conclusions

High blood pressure requiring intravenous therapy is currently managed with a variety of agents in Europe, with those most commonly used being nitroglycerine, urapidil and clonidine. Patients with acute hypertension have substantial concomitant morbidity and mortality, and intravenous antihypertensive treatment is associated with hypotension in almost 10% of cases.