Is systolic blood pressure high in patients with acute aortic dissection on first medical contact before hospital transfer?

Tokyo CCU Network and Tokyo Acute Aortic Super Network

Research output: Contribution to journalArticle

Abstract

Acute aortic dissection (AAD) cases are thought to have high blood pressure (BP) on admission; however, little data are available on BP prior to admission. The purpose of this study was to investigate systolic blood pressure (SBP) very early after symptom onset and before hospital transfer in patients with AAD to determine whether SBPs were high, and also whether SBPs were higher or lower compared with SBPs at hospital admission. We obtained results using three-year data derived from the Tokyo Acute Aortic Super Network Database. First, we selected 830 patients with AAD for which the “duration from symptom onset to first medical contact by ambulance crews” (SO-FMC) was within 60 min. We examined the SBPs of such patients. Next, we selected 222 patients with AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, and compared SBPs at FMC with those at hospital admission. Among types A (n = 190) and B (n = 117), in patients with an SO-FMC ≤ 15 min, the median SBP was 100 mmHg and 178 mmHg (p < 0.001), respectively; 9% and 50% (p < 0.001) of such patients, respectively, exhibited an SBP ≥ 180 mmHg; and 43% and 10% (p < 0.001) of such patients, respectively, had an SBP < 90 mmHg. Of patients with types A (n = 124) and B (n = 98) AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, SBPs at FMC were higher than those at hospital admission for the SBP ≥ 180 mmHg subgroups of both type A (194 mmHg vs. 159 mmHg, p < 0.001) and type B (199 mmHg vs. 186 mmHg, p < 0.001). Approximately 10 min after symptom onset and before hospital transfer, the measured SBPs of many patients with type A AAD were not necessarily high. However, the SBPs of cases with type B AAD were high as previously reported for SBP on admission. In addition, for the subgroup of SBP ≥ 180 mmHg at FMC within 15 min after symptom onset, SBPs at FMC were significantly higher than those at hospital admission for both types A and B; the higher SBP at symptom onset may have been partially associated with being a trigger of AD.

Original languageEnglish
JournalHeart and vessels
DOIs
Publication statusPublished - 2019 Jan 1

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Dissection
Blood Pressure
Hypertension
Patient Transfer
Ambulances
Tokyo
Databases

Keywords

  • Aortic dissection
  • Hypertension
  • Type A
  • Type B

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Is systolic blood pressure high in patients with acute aortic dissection on first medical contact before hospital transfer? / Tokyo CCU Network and Tokyo Acute Aortic Super Network.

In: Heart and vessels, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Is systolic blood pressure high in patients with acute aortic dissection on first medical contact before hospital transfer?",
abstract = "Acute aortic dissection (AAD) cases are thought to have high blood pressure (BP) on admission; however, little data are available on BP prior to admission. The purpose of this study was to investigate systolic blood pressure (SBP) very early after symptom onset and before hospital transfer in patients with AAD to determine whether SBPs were high, and also whether SBPs were higher or lower compared with SBPs at hospital admission. We obtained results using three-year data derived from the Tokyo Acute Aortic Super Network Database. First, we selected 830 patients with AAD for which the “duration from symptom onset to first medical contact by ambulance crews” (SO-FMC) was within 60 min. We examined the SBPs of such patients. Next, we selected 222 patients with AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, and compared SBPs at FMC with those at hospital admission. Among types A (n = 190) and B (n = 117), in patients with an SO-FMC ≤ 15 min, the median SBP was 100 mmHg and 178 mmHg (p < 0.001), respectively; 9{\%} and 50{\%} (p < 0.001) of such patients, respectively, exhibited an SBP ≥ 180 mmHg; and 43{\%} and 10{\%} (p < 0.001) of such patients, respectively, had an SBP < 90 mmHg. Of patients with types A (n = 124) and B (n = 98) AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, SBPs at FMC were higher than those at hospital admission for the SBP ≥ 180 mmHg subgroups of both type A (194 mmHg vs. 159 mmHg, p < 0.001) and type B (199 mmHg vs. 186 mmHg, p < 0.001). Approximately 10 min after symptom onset and before hospital transfer, the measured SBPs of many patients with type A AAD were not necessarily high. However, the SBPs of cases with type B AAD were high as previously reported for SBP on admission. In addition, for the subgroup of SBP ≥ 180 mmHg at FMC within 15 min after symptom onset, SBPs at FMC were significantly higher than those at hospital admission for both types A and B; the higher SBP at symptom onset may have been partially associated with being a trigger of AD.",
keywords = "Aortic dissection, Hypertension, Type A, Type B",
author = "{Tokyo CCU Network and Tokyo Acute Aortic Super Network} and Koichi Akutsu and Hideaki Yoshino and Tomoki Shimokawa and Hitoshi Ogino and Takashi Kunihara and Toshiyuki Takahashi and Michio Usui and Kazuhiro Watanabe and Tetsuya Tobaru and Kenichi Hagiya and Wataru Shimizu and Tetsuya Niino and Mitsuhiro Kawata and Hiroshi Masuhara and Yoshinori Watanabe and Nobuko Yoshida and Takeshi Yamamoto and Ken Nagao and Morimasa Takayama and Jiro Aoki and Tsuyoshi Taketani and Tadateru Takyama and Masashi Tanaka and Kosaku Kinoshita and Hiroshi Iwata and Shizuyuki Doi and Ryo Fukui and Hiromasa Yamashita and Satoshi Otsubo and Kazuhiko Sekine and Norikazu Watanabe and Atsushi Aoki and Kenji Doi and Shuichiro Takanashi and Kazuhito Suzuki and Atsushi Mizuno and Hiroyasu Misumi and Shinichi Ishimatsu and Yuichiro Minami and Arino Yaguchi and Katsumi Saito and Ahikito Sasaki and Yusuke Watanabe and Tetsuya Sakamoto and Hiroaki Senba and Haruo Mitani and Katsunori Yoshihara and Katsunori Yoshihara and Mitsumasa Hata and Hideyuki Shimizu",
year = "2019",
month = "1",
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AU - Tokyo CCU Network and Tokyo Acute Aortic Super Network

AU - Akutsu, Koichi

AU - Yoshino, Hideaki

AU - Shimokawa, Tomoki

AU - Ogino, Hitoshi

AU - Kunihara, Takashi

AU - Takahashi, Toshiyuki

AU - Usui, Michio

AU - Watanabe, Kazuhiro

AU - Tobaru, Tetsuya

AU - Hagiya, Kenichi

AU - Shimizu, Wataru

AU - Niino, Tetsuya

AU - Kawata, Mitsuhiro

AU - Masuhara, Hiroshi

AU - Watanabe, Yoshinori

AU - Yoshida, Nobuko

AU - Yamamoto, Takeshi

AU - Nagao, Ken

AU - Takayama, Morimasa

AU - Aoki, Jiro

AU - Taketani, Tsuyoshi

AU - Takyama, Tadateru

AU - Tanaka, Masashi

AU - Kinoshita, Kosaku

AU - Iwata, Hiroshi

AU - Doi, Shizuyuki

AU - Fukui, Ryo

AU - Yamashita, Hiromasa

AU - Otsubo, Satoshi

AU - Sekine, Kazuhiko

AU - Watanabe, Norikazu

AU - Aoki, Atsushi

AU - Doi, Kenji

AU - Takanashi, Shuichiro

AU - Suzuki, Kazuhito

AU - Mizuno, Atsushi

AU - Misumi, Hiroyasu

AU - Ishimatsu, Shinichi

AU - Minami, Yuichiro

AU - Yaguchi, Arino

AU - Saito, Katsumi

AU - Sasaki, Ahikito

AU - Watanabe, Yusuke

AU - Sakamoto, Tetsuya

AU - Senba, Hiroaki

AU - Mitani, Haruo

AU - Yoshihara, Katsunori

AU - Yoshihara, Katsunori

AU - Hata, Mitsumasa

AU - Shimizu, Hideyuki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Acute aortic dissection (AAD) cases are thought to have high blood pressure (BP) on admission; however, little data are available on BP prior to admission. The purpose of this study was to investigate systolic blood pressure (SBP) very early after symptom onset and before hospital transfer in patients with AAD to determine whether SBPs were high, and also whether SBPs were higher or lower compared with SBPs at hospital admission. We obtained results using three-year data derived from the Tokyo Acute Aortic Super Network Database. First, we selected 830 patients with AAD for which the “duration from symptom onset to first medical contact by ambulance crews” (SO-FMC) was within 60 min. We examined the SBPs of such patients. Next, we selected 222 patients with AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, and compared SBPs at FMC with those at hospital admission. Among types A (n = 190) and B (n = 117), in patients with an SO-FMC ≤ 15 min, the median SBP was 100 mmHg and 178 mmHg (p < 0.001), respectively; 9% and 50% (p < 0.001) of such patients, respectively, exhibited an SBP ≥ 180 mmHg; and 43% and 10% (p < 0.001) of such patients, respectively, had an SBP < 90 mmHg. Of patients with types A (n = 124) and B (n = 98) AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, SBPs at FMC were higher than those at hospital admission for the SBP ≥ 180 mmHg subgroups of both type A (194 mmHg vs. 159 mmHg, p < 0.001) and type B (199 mmHg vs. 186 mmHg, p < 0.001). Approximately 10 min after symptom onset and before hospital transfer, the measured SBPs of many patients with type A AAD were not necessarily high. However, the SBPs of cases with type B AAD were high as previously reported for SBP on admission. In addition, for the subgroup of SBP ≥ 180 mmHg at FMC within 15 min after symptom onset, SBPs at FMC were significantly higher than those at hospital admission for both types A and B; the higher SBP at symptom onset may have been partially associated with being a trigger of AD.

AB - Acute aortic dissection (AAD) cases are thought to have high blood pressure (BP) on admission; however, little data are available on BP prior to admission. The purpose of this study was to investigate systolic blood pressure (SBP) very early after symptom onset and before hospital transfer in patients with AAD to determine whether SBPs were high, and also whether SBPs were higher or lower compared with SBPs at hospital admission. We obtained results using three-year data derived from the Tokyo Acute Aortic Super Network Database. First, we selected 830 patients with AAD for which the “duration from symptom onset to first medical contact by ambulance crews” (SO-FMC) was within 60 min. We examined the SBPs of such patients. Next, we selected 222 patients with AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, and compared SBPs at FMC with those at hospital admission. Among types A (n = 190) and B (n = 117), in patients with an SO-FMC ≤ 15 min, the median SBP was 100 mmHg and 178 mmHg (p < 0.001), respectively; 9% and 50% (p < 0.001) of such patients, respectively, exhibited an SBP ≥ 180 mmHg; and 43% and 10% (p < 0.001) of such patients, respectively, had an SBP < 90 mmHg. Of patients with types A (n = 124) and B (n = 98) AAD whose SBPs were measured both at FMC, within 15 min after symptom onset, and at hospital admission, SBPs at FMC were higher than those at hospital admission for the SBP ≥ 180 mmHg subgroups of both type A (194 mmHg vs. 159 mmHg, p < 0.001) and type B (199 mmHg vs. 186 mmHg, p < 0.001). Approximately 10 min after symptom onset and before hospital transfer, the measured SBPs of many patients with type A AAD were not necessarily high. However, the SBPs of cases with type B AAD were high as previously reported for SBP on admission. In addition, for the subgroup of SBP ≥ 180 mmHg at FMC within 15 min after symptom onset, SBPs at FMC were significantly higher than those at hospital admission for both types A and B; the higher SBP at symptom onset may have been partially associated with being a trigger of AD.

KW - Aortic dissection

KW - Hypertension

KW - Type A

KW - Type B

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