Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Abstract

Background: The incidence of hypertensive emergency in US emergency departments (ED) is not well established.

Methods and results: This study is a descriptive epidemiological analysis of nationally representative ED visit-level data from the Nationwide Emergency Department Sample for 2006-2013. Nationwide Emergency Department Sample is a publicly available database maintained by the Healthcare Cost and Utilization Project. An ED visit was considered to be a hypertensive emergency if it met all the following criteria: diagnosis of acute hypertension, at least 1 diagnosis indicating acute target organ damage, and qualifying disposition (admission to the hospital, death, or transfer to another facility). The incidence of adult ED visits for acute hypertension increased monotonically in the period from 2006 through 2013, from 170 340 (1820 per million adult ED visits overall) to 496 894 (4610 per million). Hypertensive emergency was rare overall, accounting for 63 406 visits (677 per million adult ED visits overall) in 2006 to 176 769 visits (1670 per million) in 2013. Among adult ED visits that had any diagnosis of hypertension, hypertensive emergency accounted for 3309 per million in 2006 and 6178 per million in 2013.

Conclusions: The estimated number of visits for hypertensive emergency and the rate per million adult ED visits has more than doubled from 2006 to 2013. However, hypertensive emergencies are rare overall, occurring in about 2 in 1000 adult ED visits overall, and 6 in 1000 adult ED visits carrying any diagnosis of hypertension in 2013. This figure is far lower than what has been sometimes cited in previous literature.

Keywords: cost; high blood pressure; hypertension; hypertensive emergency; hypertensive urgency; utilization.

Figure 1

Study design and sample, NEDS 2006–2013. ICD‐9 CM codes: malignant hypertension (401.0) including hypertensive heart/kidney disease (402.00, 402.01, 403.00, 403.01, 404.00, 404.01, 404.02, 404.03), target organ damage including any 1 of the following: retinal hemorrhage (362.81), papilledema with increased intracranial pressure (377.01), acute or unspecified (not chronic) heart failure (428.0, 428.1, 428.20, 428.21, 428.23, 428.30, 428.31, 428.33, 428.40, 428.41, 428.43, 428.9), acute myocardial infarction/acute coronary occlusion (410.x), ruptured aneurysm or dissection of a major vessel (414.12, 443.21, 443.22, 443.23, 443.24, 443.29, 441.x), subarachnoid hemorrhage (430.x), intracerebral hemorrhage (431.x), nontraumatic extradural hemorrhage (432.x), cerebral thrombosis (434.x), transient cerebral ischemia (435.x), other cerebrovascular disease (436.x), or hypertensive encephalopathy (437.2). ED indicates emergency department; ICD‐9 CM, International Classification of Diseases, Ninth Revision, Clinical Modification; NEDS, Nationwide Emergency Department Sample.

Figure 2

Trends in the incidence of hypertensive emergency in US Emergency Departments, 2006–2013. ED indicates emergency department; TOD, target organ damage; the right‐sided vertical axis is for number of total ED visits; the left‐sided vertical axis is for ED visits meeting each of the criteria given.