RATIONALE & OBJECTIVE Severe hypertension (sHTN) that develops after hospital admission is prevalent in 10% of patients admitted for reasons other than HTN. sHTN is commonly treated with intravenous (IV) antihypertensives and is associated with a greater risk of acute kidney injury (AKI). Our goal was to explore whether there is heterogeneity in IV antihypertensives' effect on AKI incidence among patients who develop sHTN during hospitalization. STUDY DESIGN Heterogeneity of treatment effect analysis. SETTINGS & PARTICIPANTS Patients who developed sHTN, systolic blood pressure (BP) >180, or diastolic BP >110 mmHg during hospitalization and did not have kidney failure. EXPOSURE Treatment with IV antihypertensives within 3 hours of BP elevation. OUTCOME Time to develop AKI. ANALYTICAL APPROACH An accelerated failure time Bayesian Additive Regression Trees (BART) model to capture the association between the time to develop AKI and predictors. Individual treatment effects estimated for each participant using a counterfactual outcome framework and these estimates were used to identify patient characteristics associated with treatment effect heterogeneity in response to IV antihypertensives. RESULTS We included 11,951 patients who developed sHTN, 741 were treated with IV antihypertensives, and 11,210 were not, of which 18% and 13% developed AKI, respectively. Most patients would have been harmed from IV antihypertensive treatment except for a small subset of 317 patients who were White, had an SBP on admission ≥156 mmHg, an eGFR ≥70.7 ml/min/1.73m2, and a serum bicarbonate <21.7 mmol/L. LIMITATIONS Data-driven, hypothesis-generating approach. Findings were not validated with external data sources. CONCLUSION These exploratory findings suggest that most patients who develop sHTN will not benefit from IV antihypertensive treatment. Future studies should assess for heterogeneity when identifying treatment options, if any are needed, for sHTN.

中文翻译：

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治疗效果 住院期间严重血压升高静脉降压药后急性肾损伤发生率的异质性。


基本原理和目标：在因高血压以外的原因入院的患者中，有10%的患者普遍患有严重高血压（sHTN）。sHTN 通常使用静脉注射 （IV） 抗高血压药进行治疗，并且与急性肾损伤 （AKI） 的风险增加有关。我们的目标是探讨静脉降压药对住院期间发生 sHTN 的患者 AKI 发病率的影响是否存在异质性。研究设计 治疗效果分析的异质性。设置和参与者 在住院期间出现sHTN、收缩压（BP）>180或舒张压>110 mmHg且未出现肾衰竭的患者。暴露 血压升高后 3 小时内用静脉注射降压药治疗。结果 是时候发展 AKI 了。分析方法 加速失效时间贝叶斯加性回归树 （BART） 模型，用于捕获发生 AKI 的时间与预测变量之间的关联。使用反事实结果框架估计每个参与者的个体治疗效果，这些估计值用于确定与对 IV 抗高血压药的治疗效果异质性相关的患者特征。结果 我们纳入了 11,951 例发生 sHTN 的患者，其中 741 例接受了静脉降压药治疗，11,210 例未接受静脉降压药治疗，其中 18% 和 13% 分别发生 AKI。除了一小部分 317 名患者外，大多数患者会因静脉注射降压治疗而受到伤害，这些患者是白人，入院时 SBP ≥156 mmHg，eGFR ≥70.7 ml/min/1.73m2，血清碳酸氢盐 <21.7 mmol/L。局限性 数据驱动、假设生成方法。研究结果未使用外部数据源进行验证。 结论 这些探索性发现表明，大多数发生 sHTN 的患者不会从静脉降压治疗中受益。未来的研究在确定 sHTN 的治疗方案（如果需要）时应评估异质性。