Abstract TP215: Principal Hospital Admission Of Hypertension Foreshadows 3-month Ischemic And Hemorrhagic Stroke

Abstract

Introduction: Hypertension is a well-recognized risk factor for acute ischemic stroke (AIS) and intraparenchymal hemorrhagic (IPH). We performed a nationwide analysis to evaluate the rate of AIS and IPH readmission comparing patients with hypertension as a principal versus non-principal diagnosis. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with index admission diagnosis (principal or non-principal) of hypertension from 2016 to 2018. Hypertension, AIS, IPH, and other diagnoses were identified based on standard ICD-10 CM codes. Patients with AIS or IPH diagnoses during the index admission were excluded. We determined post-discharge 90-day admission trends by Kaplan-Meier estimates in patients with principal versus non-principal diagnosis of hypertension. We then constructed Cox regression models to determine associations between principal diagnosis of hypertension and AIS or IPH admission rates, with adjustment to age, gender, insurance type, zip code income quartile, index admission disposition, and Elixhauser comorbidities. Results: Of the 36,173,682 patients identified, 586,613 (1.62%) had a principal diagnosis of hypertension during the index admission. Patients with a principal diagnosis of hypertension were more likely to have an AIS or IPH during 90-day follow up versus non-principal diagnosis of hypertension (Figure). In the Cox regression model after the aforementioned adjustments, a principal diagnosis of hypertension was significantly associated with AIS (HR 2.37, 95% CI 2.23-2.53, P < 0.001) and IPH admission (HR 2.25, 95% CI 1.97-2.56, P < 0.001). Conclusion: Patients with hypertensive conditions warranting hospitalization as principal diagnosis are at increased risk of AIS and IPH in the first 90-days after discharge. Post-discharge planning should include intensive ambulatory blood pressure monitoring and control by outpatient providers.