Study: Many Cardiovascular Emergencies Related to Poorly Controlled High Blood Pressure

A new study analyzing more than 20 million emergency department (ED) visits indicates that many cardiovascular (CVD) emergencies are due to poorly controlled high blood pressure. The research was published in the Journal of the American Heart Association.

The research team found that 13% of all heart-related ED diagnoses were for “essential” hypertension, which is high blood pressure not caused by other diseases. Most cases of high blood pressure are essential hypertension, according to the study authors.

“These visits resulted in hospital admission less than 3% of the time and with very few deaths—less than 0.1%. This suggests that these visits were mostly related to the management of hypertension,” said lead study author Mamas A. Mamas, MD, a professor of cardiology at Keele University in Stoke-on-Trent, and a consultant cardiologist at University Hospitals of North Midlands NHS Trust, in a press release.

Out of the 15 CVD conditions detailed in the study, approximately 30% were hypertension-related diagnoses. The study specifically analyzed cardiovascular diagnoses made during ED visits as part of the Nationwide Emergency Department Sample from 2016-2018. The sample was comprised for 48.7% women with an average age of 67 years. Most of the patients were on Medicare or Medicaid.

The men who were included in the sample were more likely to have other diseases in addition to CVD, such as diabetes, whereas women had higher rates of obesity, high blood pressure, and medical conditions that affect blood vessels in the brain.

For women who admitted to the ED, the most common heart- or stroke-related diagnoses were high blood pressure (16%), high blood pressure-related heart or kidney disease (14.1%), and atrial fibrillation (10.2%). The most common diagnoses seen in men were high blood pressure-related heart or kidney disease (14.7%), high blood pressure (10.8%), and heart attack (10.7%).

“Previous studies have shown sex differences in patterns of CVD among hospitalized patients,” Mamas said in a press release. “However, examining CVD encounters in the emergency department provides a more complete picture of the cardiovascular health care needs of men and women, as it captures encounters prior to hospitalization.”

Mamas also added that previous studies of CVD ED visits are limited to suspected heart attack visits.

“Therefore, this analysis of 15 CVD conditions helps to better understand the full spectrum of acute CVD needs, including sex disparities in hospitalization and risk of death,” he said in a press release.

The outcomes from the study showed that the emergency CVD visits were slightly different for men and women. Overall, women were less likely to die or be hospitalized after an ED visit for CVD. The study authors concluded that the difference may be due to women’s generally lower risk diagnoses, but there could be an underestimation of deaths in women.

“We did not track deaths outside of the hospital setting,” Mamas said in a press release. “Given past evidence that women are more likely to be inappropriately discharged from the emergency department, and strong evidence for the systemic undertreatment of women, further study is warranted to track outcomes beyond the emergency department visit.”

There were limitations to the study, which included potential misdiagnosis errors in cases in which the final diagnosis did not match the emergency diagnosis, mainly after a hospitalization and additional bloodwork, and other health information could be acquired. Further, the data were limited in capturing information related to severity of disease, which may make comparisons around mortality differences between different patient groups challenging.

“Our work with this large, nationally representative sample of cardiovascular emergency visits highlights differences in health care needs of men and women, which may be useful to inform planning and provision of health care services,” Mamas said in a press release. “We also encourage further research into understanding the underlying factors driving the differences in CVD patterns and outcomes between men and women.”

REFERENCE

Many heart-related emergencies are due to uncontrolled blood pressure. American Heart Association. September 20, 2022. Accessed September 26, 2022. https://newsroom.heart.org/news/many-heart-related-emergencies-are-due-to-uncontrolled-blood-pressure