Abstract 167: Intracerebral Hemorrhage After Emergency Department Visits for Hypertension

Abstract

Introduction: Although common, severe hypertension in the emergency department (ED) has not been well studied. Current guidelines recommend against aggressive treatment of acutely hypertensive ED patients without end-organ failure and instead recommend initiation of oral antihypertensive agents and outpatient follow-up. However, recent data suggests that intracerebral hemorrhage (ICH) often occurs shortly after an acute rise in blood pressure. Hypothesis: We hypothesized that patients discharged from the ED with hypertension face an increased risk of ICH in subsequent weeks. Methods: Using administrative claims data from CA, NY, and FL, we identified all patients discharged from the ED from 2005 through 2011 with a primary diagnosis of hypertension (ICD-9-CM codes 401-405). Patients were excluded if they were hospitalized from the ED or had prior histories of cerebrovascular disease at the index visit with hypertension. Using the Mantel-Haenszel estimator for matched data, we compared each patient’s odds of ICH during days 8-38 after ED discharge to the same patient’s odds during days 373-403 after discharge. This cohort-crossover design with a one-week washout period enabled individual patients to serve as their own controls, thereby minimizing confounding bias. Results: Among 552,569 patients discharged from the ED with a primary diagnosis of hypertension, 93 (0.017%) were diagnosed with ICH during days 8-38 after discharge compared to 70 (0.013%) during days 373-403 (OR 1.33, 95% CI 0.96-1.84). The odds of ICH were increased in certain subgroups of patients (≥60 years of age and those with secondary discharge diagnoses besides hypertension), but absolute risks were low in all subgroups. Conclusions: Contrary to our hypothesis, patients with ED visits for hypertension did not face an increased short-term risk of ICH after discharge. These findings support current guidelines for the ED management of patients with acute hypertension.