Abstract 090: Outcomes of Hypertensive Crises as Predicted by Red Cell Distribution Width

Background: Red cell distribution width (RDW) is a measure of the variability in size of erythrocytes. A high RDW value indicates greater variation in size between individual erythrocytes and has been shown to be an independent predictor of mortality in patients with coronary artery disease, heart failure and in patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to evaluate the prognostic value of RDW in predicting clinical outcomes in patients with hypertensive crisis. Methods: We performed a retrospective study of 465 consecutive patients from January 2007 to March 2010 who presented with hypertensive crisis. Hypertensive crisis was defined as systolic BP >180 and/or diastolic BP >110mmHg with impending or progressive end organ dysfunction requiring inpatient hospitalization. The study sample consisted of 465 patients (38.9% men (181 of 465); mean age 59.6 ± 15.9). Baseline levels of RDW were measured at time of admission and analyzed as continuous and categorical variables (elevated RDW was defined as >14.5%). Multivariable regression analysis was performed for development of all-cause mortality, myocardial infarction, new-onset heart failure (defined as first time hospital admission for heart failure), stroke and MACE (MI, new-onset heart failure and stroke) at 2 years. Results: RDW > 14.5% was a strong independent predictor of all-cause mortality at 2 years (OR: 1.90, 95% CI: 1.1-3.3, p <0.05). Elevated RDW was also found to be an independent predictor of new-onset heart failure at 2 years (OR: 1.97, 95% CI: 1.1-3.7, p <0.05). Elevated RDW was not a predictor of MI, PCI or stroke at 2 years. Conclusions: Elevated RDW level in patients with hypertensive crisis was an independent predictor of all-cause mortality and new-onset heart failure in patients with hypertensive crisis.