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.
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Acknowledgements
The authors thank participating hospitals and leading members of the Tokyo CCU Network and Tokyo AAS Network. Participating Hospitals and Leading Members of the Tokyo CCU Network and Tokyo Acute Aortic Super Network: Mitsui Memorial Hospital, Jiro Aoki, Tsuyoshi Taketani; Nihon University Itabashi Hospital, Tadateru Takyama, Masashi Tanaka, Kosaku Kinoshita; Juntendo University Hospital, Hiroshi Iwata, Shizuyuki Doi; Toho University, Ohashi Medical Center, Ryo Fukui, Hiromasa Yamashita; Saiseikai Central Hospital, Toshiyuki Takahashi, Satoshi Otsubo, Kazuhiko Sekine; Showa University Hospital, Norikazu Watanabe, Atsushi Aoki, Kenji Doi; Sakakibara Heart Institute, Tetsuya Tobaru, Shuichiro Takanashi; Kosei General Hospital, Kazuhito Suzuki; St.Luke's International Hospital, Atsushi Mizuno, Hiroyasu Misumi, Shinichi Ishimatsu; Tokyo Women's Medical University Hospital, Yuichiro Minami, Arino Yaguchi; Nishiarai Heart Center Hospital, Katsumi Saito, Ahikito Sasaki; Teikyo University Hospital, Yusuke Watanabe, Tomoki Shimokawa, Tetsuya Sakamoto; The Cardiovascular Institute, Hiroaki Senba, Takashi Kunihara; Toranomon Hospital, Haruo Mitani; Toho University Omori Medical Center, Katsunori Yoshihara, Yoshinori Watanabe, Katsunori Yoshihara; Nihon University Hospital, Kazuhiro Watanabe, Mitsumasa Hata, Kenji Akiyama; Tokyo Medical University Hachioji Medical Center, Youhei Hokama, Shunya Shindo, Takao Arai; Kyorin University Hospital, Toshinori Minamishima, Hiroshi Kubota, Yoshihiro Yamaguchi; Tokyo Metropolitan Geriatric Hospital, Hajime Fujimoto, Takashi Nishimura; Tokyo Metropolitan Hiroo Hospital, Takaaki Tsuchiyama, Masazumi Watanabe, Hideaki Goto; Nippon Medical School Hospital, Shuhei Tara, Tetsuro Morota, Hiroyuki Yokota; Tokyo Women's Medical University Medical Center East, Shun Nakajima, Ryuta Asano, Tomohisa Shoko; Bokutoh Metropolitan General Hospital, Norihiro Kuroki, Susumu Ishikawa, Yuichi Hamabe; Tobu Chiiki Hospital, Takashi Tamura; Musashino Red Cross Hospital, Toshihiro Nozato, Tomoya Yoshizaki, Shinichiro Suzaki; Showa General Hospital, Shigehiro Tanaka, Yasusei Okada; Tokyo Metropolitan Tama Medical Center, Hiroyuki Tanaka, Toshiya Otsuka, Keiki Shimizu; Disaster Medical Center, Shigeo Shimizu, Tetsuya Niino, Yuichi Koido; Ome Municipal General Hospital, Ken Kurihara, Takeshi Someya, Masato Kawakami, Edogawa Hospital, Hiroshi Oohira; Tokyo Rinkai Hospital, Kazumiki Nomoto; Jikei University, Katsushika Medical Center, Takeyuki Kubota, IMS Katsushika Heart Center, Masayoshi Sakakibara, Takeyuki Kanemura; Ayase Heart Hospital, Imun Tei; Hakujikai Memorial Hospital, Yasuhiro Hirasawa; The Jikei University Hospital, Satoshi Morimoto, Kazuhiro Hashimoto; Kanto Medical Center NTT EC, Masashiro Matsushita, Ko Shibata; Ikegami General Hospital, Yasufumi Hayama, Yukio Suto; The University of Tokyo Hospital; Yumiko Hosoya, Haruo Yamauchi, Naoto Morimura; Tokyo Metropolitan Police Hospital, Shuzo Tanimoto; Mishuku Hospital, Hirotsugu Tabata; Keio University Hospital, Takashi Kohno, Hideyuki Shimizu, Tokyo Medical University Hospital, Ryosuke Ito, Hitoshi Ogino, Jun Oda; National Center for Global Health and Medicine, Hisao Hara, Tetsuya Horai, Akio Kimura; Kawakita General Hospital, Yoichi Sugimura; Itabashi Chuo Medical Center, Hiroshi Ota, Seiichiro Murata; Toshima Hospital, Hitoshi Saeki; Nishitokyo Central General; Hospital, Shigeki Ito; Higashiyamato Hospital, Ryuichi Kato, Takayuki Tatebayashi; Tokai University, Hachioji-hospital, Keiko Oikawa; Nippon Medical School Tama-Nagayama Hospital, Eitaro Kodani, Kyoko Unemoto; Tama Nambu Chiiki Hospital, Tatenori Suzuki; Tokyo Medical and Dental University, Taro Shinooka, Tsuyoshi Hachimaru, Yasuhiro Otomo; Japanese Red Cross Medical Center, Hiroshi Ikenouchi, Munehiro Hayashi; Kanto Central Hospital, Hiroshi Yamashita, Katsuhiko Kasahara; National Hospital Organization Tokyo Medical Center, Yukihiko Momiyama, Motohiko Osako, Takaaki Kikuno; JCHO Tokyo Yamate Medical Center, Michio Usui; JCHO Tokyo Shinjuku Medical Center, Seiji Ayabe; Jikei University Daisan Hospital, Takahiro Shibata; Tokyo-kita Medical Center, Takuji Katayama; Tokyo Heart Center, Joji Hosokawa; Ogikubo Hospital, Yasuhiro Ishii, Tadashi Isomura; Tama-Hokubu Medical Center, Satoshi Murasaki, Shigeharu Sawa; Meirikai Chuo General Hospital, Mizuki Hirose; The Juntendo University Nerima Hospital, Yasumasa Fujiwara, Tomohiro Iwakura; Fuchu Keijinkai Hospital, Susumu Ui; The Fraternity Memorial Hospital, Yasuhiro Takahashi; Omori Red Cross Hospital, Yasuyuki Mochida; Tokyo Nishi Tokushukai Hospital, Hiroshi Domae.
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The Tokyo CCU network data registry is financially supported by the Tokyo Metropolitan Government. This research did not receive a grant from any funding agency in the public, commercial or not-for-profit sectors.
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M.T. Reports receiving lecture fees from Daiichi Sankyo Pharmaceutical Co. Ltd., outside of the submitted work. All authors declare that there is no conflict of interest.
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The members of the 'Tokyo CCU Network and Tokyo Acute Aortic Super Network' are listed in acknowledgements section.
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Akutsu, K., Yoshino, H., Shimokawa, T. et al. Is systolic blood pressure high in patients with acute aortic dissection on first medical contact before hospital transfer?. Heart Vessels 34, 1748–1757 (2019). https://doi.org/10.1007/s00380-019-01419-9
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DOI: https://doi.org/10.1007/s00380-019-01419-9