BACKGROUND:Chronic hypertension is an established long-term risk factor for major adverse cardiovascular events (MACEs). However, little is known about short-term MACE risk after hypertensive urgency, defined as an episode of acute severe hypertension without evidence of target-organ damage. We sought to evaluate the short-term risk of MACE after an emergency department (ED) visit for hypertensive urgency resulting in discharge to home.METHODS:We performed a case-crossover study using deidentified administrative claims data. Our case periods were 1-week intervals from 0 to 12 weeks before hospitalization for MACE. We compared ED visits for hypertensive urgency during these case periods versus equivalent control periods 1 year earlier. Hypertensive urgency and MACE components were all ascertained using previously validated International Classification of Diseases, Tenth RevisionClinical Modification codes. We used McNemar test for matched data to calculate risk ratios.RESULTS:Among 2 225 722 patients with MACE, 1 893 401 (85.1%) had a prior diagnosis of hypertension. There were 4644 (0.2%) patients who had at least 1 ED visit for hypertensive urgency during the 12 weeks preceding their MACE hospitalization. An ED visit for hypertensive urgency was significantly more common in the first week before MACE compared with the same chronological week 1 year earlier (risk ratio, 3.5 [95% CI, 2.9–4.2]). The association between hypertensive urgency and MACE decreased in magnitude with increasing temporal distance from MACE and was no longer significant by 11 weeks before MACE (risk ratio, 1.2 [95% CI, 0.99–1.6]).CONCLUSIONS:ED visits for hypertensive urgency were associated with a substantially increased short-term risk of subsequent MACE.

中文翻译：

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因高血压急症前往急诊室就诊后发生重大不良心血管事件的风险

背景：慢性高血压是主要不良心血管事件（MACE）的既定长期危险因素。然而，对于高血压急症（定义为没有靶器官损伤证据的急性严重高血压发作）后的短期 MACE 风险知之甚少。我们试图评估因高血压急症前往急诊室 (ED) 就诊并出院回家后发生 MACE 的短期风险。方法：我们使用去识别化的行政索赔数据进行了病例交叉研究。我们的病例周期为 1 周间隔，从 MACE 住院前 0 周到 12 周。我们将这些病例期间的急诊就诊与一年前的同等对照期间进行了比较。高血压急症和 MACE 成分均使用先前验证的国际疾病分类第十版临床修改代码来确定。采用McNemar检验匹配数据计算危险比。结果：2 225 722例MACE患者中，1 893 401例（85.1%）既往诊断为高血压。有 4644 名患者 (0.2%) 在 MACE 住院前 12 周内至少因高血压急症就诊 1 次急诊室。与 1 年前同一时间周相比，在 MACE 发生前第一周因高血压急症就诊的情况明显更为常见（风险比，3.5 [95% CI，2.9-4.2]）。高血压急症与 MACE 之间的关联程度随着距 MACE 的时间距离的增加而减弱，并且到 MACE 前 11 周时不再显着（风险比为 1.2 [95% CI，0.99–1.6]）。结论：高血压急症就诊的急诊室与随后 MACE 的短期风险大幅增加相关。