Hypertensive Emergency in Heart Failure: Trends, Risk factors and Outcomes from a Nationwide Analysis 2005–2014

Introduction: Heart failure (HF) patients may be susceptible to complications of hypertensive emergency (HTNE). Large registries have found that these patients are not on optimal antihypertensive therapy. To date, little investigation has been done on HF patients with HTNE, and their clinical risk factors/outcomes have not been well defined. Methods: We reviewed the National Inpatient Sample database to collect data on HF patient hospitalizations from 2005 to 2014. HF patients with and without a primary diagnosis of HTNE were included in the analysis. Risk factors and outcomes of HF patients with a primary diagnosis of HTNE were compared to those without HTNE. HF patients with a primary diagnosis of shock of any etiology were excluded. Results: Of 8,265,792 patients hospitalized with HF, 39,170 (0.5%) had HTNE. There was a threefold increase in the incidence of HTNE in HF patients over a 10-year period. The increase was more evident in females, Blacks and those < 40 years of age. There was also an increasing trend in modifiable risk factors. HF patients with HTNE had significantly higher major in-hospital complications compared to those without HTNE. However, this association did not reflect an increase in short-term in-hospital mortality, irrespective of age. Conclusion: HF patients with HTNE represent a unique population that requires a different approach to treatment. Further research is needed to identify barriers preventing adequate therapy of hypertension and other modifiable risk factors in HF patients and assess their effects on long-term outcomes.