Admission blood pressure and blood pressure variability in medical emergency predicts 3-month mortality and readmission

Emma Hildur Jensen Malm; Anton W Petersen; Rakin Hadad; Steen B Haugaard; Michael H Olsen; Philip L Bonde; Helena Dominguez; Edina Hadziselimovic; Ahmad Sajadieh

doi:10.1097/HJH.0000000000004027

Admission blood pressure and blood pressure variability in medical emergency predicts 3-month mortality and readmission

Emma Hildur Jensen Malm^*
, Anton W Petersen
, Rakin Hadad
, Steen B Haugaard
, Michael H Olsen
, Philip L Bonde
, Helena Dominguez
, Edina Hadziselimovic
, Ahmad Sajadieh

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short-term outcome remains unknown.

METHODS: We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Copenhagen, Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease.

RESULTS: Among 951 patients included, mean age was 64 (standard deviation; 17) with 44% women. During 3-month follow-up, 284 (30%) patients met a primary outcome and 69 (7,2%) a secondary outcome. In adjusted Cox models, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome [hazard ratio 0.971, 95% confidence interval (CI) 0.948-0.995, P = 0.017] for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV greater than 10 mmHg was associated with increased cardiovascular events (hazard ratio 2.019, 95% CI 1.142-3.569, P = 0.016).

CONCLUSION: In this study, low admission SBP was associated with all-cause readmissions and mortality, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.

Original language	English
Pages (from-to)	1198-1204
Number of pages	7
Journal	Journal of hypertension
Volume	43
Issue number	7
Early online date	8 Apr 2025
DOIs	https://doi.org/10.1097/HJH.0000000000004027
Publication status	Published - 1 Jul 2025

Funding

this study was conducted with support and funding from several research grants from Bispebjerg Hospital, a grant from the private fund 'Laege Sofus Carl Emil Friis og Hustru Olga Doris Friis' Legat' and 'Helsefonden'. The funders had no role in the design, collection, analysis, or interpretation of data. Nor did the funders have any role in the writing of the manuscript or the decision for publication. All researchers were independent from the funders and no funder had access to the research data at any point in time.

Funders
Bispebjerg and Frederiksberg Hospital
Laege Sophus Carl Emil Friis og hustru Olga Doris Friis' Legat
Helsefondon

Keywords

Humans
Female
Male
Middle Aged
Patient Readmission/statistics & numerical data
Blood Pressure/physiology
Aged
Prospective Studies
Denmark/epidemiology
Emergency Service, Hospital
Patient Admission
Blood Pressure Determination
Hypertension/mortality
Cardiovascular Diseases/mortality
Prognosis
Blood pressure variability
Prospective studies
Emergency department.
Patient readmission
Follow-up studies
Cohort studies
Blood pressure
Proportional hazards models

Access to Document

10.1097/HJH.0000000000004027

Cite this

@article{a069a190c3b74e6c9c903d56a8a75472,

title = "Admission blood pressure and blood pressure variability in medical emergency predicts 3-month mortality and readmission",

abstract = "BACKGROUND: The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short-term outcome remains unknown.METHODS: We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Copenhagen, Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease.RESULTS: Among 951 patients included, mean age was 64 (standard deviation; 17) with 44\% women. During 3-month follow-up, 284 (30\%) patients met a primary outcome and 69 (7,2\%) a secondary outcome. In adjusted Cox models, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome [hazard ratio 0.971, 95\% confidence interval (CI) 0.948-0.995, P = 0.017] for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV greater than 10 mmHg was associated with increased cardiovascular events (hazard ratio 2.019, 95\% CI 1.142-3.569, P = 0.016).CONCLUSION: In this study, low admission SBP was associated with all-cause readmissions and mortality, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.",

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author = "Malm, \{Emma Hildur Jensen\} and Petersen, \{Anton W\} and Rakin Hadad and Haugaard, \{Steen B\} and Olsen, \{Michael H\} and Bonde, \{Philip L\} and Helena Dominguez and Edina Hadziselimovic and Ahmad Sajadieh",

year = "2025",

month = jul,

day = "1",

doi = "10.1097/HJH.0000000000004027",

language = "English",

volume = "43",

pages = "1198--1204",

journal = "Journal of hypertension",

issn = "0263-6352",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "7",

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TY - JOUR

T1 - Admission blood pressure and blood pressure variability in medical emergency predicts 3-month mortality and readmission

AU - Malm, Emma Hildur Jensen

AU - Petersen, Anton W

AU - Hadad, Rakin

AU - Haugaard, Steen B

AU - Olsen, Michael H

AU - Bonde, Philip L

AU - Dominguez, Helena

AU - Hadziselimovic, Edina

AU - Sajadieh, Ahmad

PY - 2025/7/1

Y1 - 2025/7/1

N2 - BACKGROUND: The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short-term outcome remains unknown.METHODS: We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Copenhagen, Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease.RESULTS: Among 951 patients included, mean age was 64 (standard deviation; 17) with 44% women. During 3-month follow-up, 284 (30%) patients met a primary outcome and 69 (7,2%) a secondary outcome. In adjusted Cox models, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome [hazard ratio 0.971, 95% confidence interval (CI) 0.948-0.995, P = 0.017] for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV greater than 10 mmHg was associated with increased cardiovascular events (hazard ratio 2.019, 95% CI 1.142-3.569, P = 0.016).CONCLUSION: In this study, low admission SBP was associated with all-cause readmissions and mortality, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.

AB - BACKGROUND: The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short-term outcome remains unknown.METHODS: We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Copenhagen, Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease.RESULTS: Among 951 patients included, mean age was 64 (standard deviation; 17) with 44% women. During 3-month follow-up, 284 (30%) patients met a primary outcome and 69 (7,2%) a secondary outcome. In adjusted Cox models, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome [hazard ratio 0.971, 95% confidence interval (CI) 0.948-0.995, P = 0.017] for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV greater than 10 mmHg was associated with increased cardiovascular events (hazard ratio 2.019, 95% CI 1.142-3.569, P = 0.016).CONCLUSION: In this study, low admission SBP was associated with all-cause readmissions and mortality, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.

KW - Humans

KW - Female

KW - Male

KW - Middle Aged

KW - Patient Readmission/statistics & numerical data

KW - Blood Pressure/physiology

KW - Aged

KW - Prospective Studies

KW - Denmark/epidemiology

KW - Emergency Service, Hospital

KW - Patient Admission

KW - Blood Pressure Determination

KW - Hypertension/mortality

KW - Cardiovascular Diseases/mortality

KW - Prognosis

KW - Blood pressure variability

KW - Prospective studies

KW - Emergency department.

KW - Patient readmission

KW - Follow-up studies

KW - Cohort studies

KW - Blood pressure

KW - Proportional hazards models

U2 - 10.1097/HJH.0000000000004027

DO - 10.1097/HJH.0000000000004027

M3 - Article

C2 - 40207605

SN - 0263-6352

VL - 43

SP - 1198

EP - 1204

JO - Journal of hypertension

JF - Journal of hypertension

IS - 7

ER -

Admission blood pressure and blood pressure variability in medical emergency predicts 3-month mortality and readmission

Abstract

Funding

Keywords

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