American Heart Association

American Heart Association

Source:

Lu Y, et al. Presentation VMP320. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).

Disclosures: Krumholz reports receiving expenses and/or personal fees from Aetna, Arnold and Porter Law Firm, Element Science, Facebook, F-Prime, IBM Watson Health, Martin/Baughman Law Firm, Massachusetts Medical Society, National Center for Cardiovascular Diseases in Beijing, Siegfried and Jensen Law Firm, UnitedHealth; co-founding Hugo Health and ReFactor Health; and receiving research grants from the Agency for Healthcare Research and Quality, American Heart Association, FDA, The Foundation for a Smoke-Free World, Johnson & Johnson, Medtronic, NIH, Shenzen Center for Health Information and State of Connecticut Department of Public Health. Lu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
November 14, 2021
2 min read
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Hospitalizations for hypertensive emergencies rose sharply in US from 1999 to 2019

Source:

Lu Y, et al. Presentation VMP320. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).

Disclosures: Krumholz reports receiving expenses and/or personal fees from Aetna, Arnold and Porter Law Firm, Element Science, Facebook, F-Prime, IBM Watson Health, Martin/Baughman Law Firm, Massachusetts Medical Society, National Center for Cardiovascular Diseases in Beijing, Siegfried and Jensen Law Firm, UnitedHealth; co-founding Hugo Health and ReFactor Health; and receiving research grants from the Agency for Healthcare Research and Quality, American Heart Association, FDA, The Foundation for a Smoke-Free World, Johnson & Johnson, Medtronic, NIH, Shenzen Center for Health Information and State of Connecticut Department of Public Health. Lu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Among Medicare fee-for-service beneficiaries, hospitalizations for hypertensive emergencies more than doubled from 1999 to 2019, according to data presented at the American Heart Association Scientific Sessions.

Harlan Krumholz

“Despite hypertension being a treatable disease, we are losing ground. Hypertension control rates are declining. Hypertension-related deaths are rising. And now we are showing that hypertension-related hospitalizations are increasing,” Harlan Krumholz, MD, SM, professor of medicine (cardiology), of investigative medicine, of public health and in the Institute for Social and Policy Studies at Yale School of Medicine and director of the Center for Outcomes Research and Evaluation, told Healio. “We have failed to focus sufficiently on hypertension and be attentive to the social determinants and behaviors that are causing us to fail to make progress. The condition is not glamorous, and the medications are generic and easily available, so there are no industry initiatives to raise awareness or propel strategies. It is a great disappointment, and we need to come together and help people to avoid preventable harm.”

Graphical depiction of data presented in article
Data were derived from Lu Y, et al. Presentation VMP320. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).

For the serial cross-sectional analysis, Yuan Lu, ScD, assistant professor at Yale School of Medicine, Krumholz and colleagues included 397,238 Medicare fee-for-service beneficiaries. The results were simultaneously published in Circulation.

The annual rates of hospitalization for hypertensive emergencies rose from 51.5 per 100,000 beneficiary-years in 1999 to 125.9 per 100,000 beneficiary-years in 2019, according to the researchers.

The absolute increase was highest in:

  • adults aged 85 years or older (1999, 66.8 per 100,000 beneficiary-years; 2019, 274.1 per 100,000 beneficiary-years);
  • women (1999, 64.9 per 100,000 beneficiary-years; 2019, 160.1 per 100,000 beneficiary-years);
  • Black patients (1999, 144.4 per 100,000 beneficiary-years; 2019, 369.5 per 100,000 beneficiary-years); and
  • patients insured by both Medicare and Medicaid (1999, 93.1 per 100,000 beneficiary-years; 2019, 270 per 100,000 beneficiary-years).

Black adults had the highest rates of hospitalizations for hypertensive emergencies. Rates were higher in the South compared with other U.S. regions.

The difference between Black beneficiaries and white beneficiaries in hospitalizations for hypertensive emergencies also rose from 1999 to 2019, according to the researchers.

“The lack of progress in reducing racial disparities in hospitalizations for acute hypertension highlights the need for new approaches to address both medical and nonmedical factors that contribute to such disparities,” the researchers wrote in Circulation.

Among patients hospitalized for acute hypertension, 30-day mortality rates dropped from 2.6% in 1999 to 1.7% in 2019, whereas 90-day mortality rates declined from 5.6% in 1999 to 3.7% in 2019, the researchers found.

Thirty-day readmission rates for patients hospitalized for acute hypertension dropped from 15.7% in 1999 to 11.8% in 2019, whereas 90-day readmission rates fell from 29.4% in 1999 to 24% in 2019.

“It seems likely that we are improving care for these patients who are hospitalized,” Krumholz told Healio. “The reduction in mortality parallels the experience in many other conditions. Some people asked me if this is because admission thresholds are dropping, so healthier people are being hospitalized. I doubt this explanation because the 20-year trend was to treat people as outpatients, if possible — and generally, you have to be higher risk to be admitted now compared with 20 years ago.”

He said hospitalizations for acute hypertension are preventable.

“We need to identify those with hypertension and make sure they have every opportunity to adopt behaviors and take medications that can keep them safe,” Krumholz told Healio. “With the new blood pressure definitions, we ought to be able to keep the majority of these people from having a dangerous blood pressure spike.”

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