Impact Of The Obesity Paradox On Outcomes Of Hypertensive Emergencies

Introduction: The "obesity paradox" is a surprising occurrence wherein obesity appears to offer a protective benefit, leading to enhanced survival rates for particular patient populations. This research seeks to explore the presence of this paradox in patients who were admitted due to hypertensive emergencies across the United States in the initial year of the COVID-19 pandemic. Methods: We examined data from the 2020 National Inpatient Sample to identify patients who were primarily admitted due to hypertensive emergency. We used ICD-10 codes to distinguish between those with and without obesity. We employed logistic and linear regression analyses and accounted for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was less than 0.05. Results: During the calendar year of 2020, there were a total of 1,221,535 admissions primarily for hypertensive emergencies, of which 282,285 (23.1%), involved patients concurrently diagnosed with obesity. After adjusting for confounding variables, patients hospitalized for hypertensive emergencies, with obesity, demonstrated a decreased in-hospital mortality risk (aOR 0.67, 95% CI 0.63 - 0.73), as well as reduced usage of vasopressor therapy (aOR 0.69, 95% CI 0.60 - 0.79), mechanical circulatory support (aOR 0.33, 95% CI 0.24 - 0.47), and hemodialysis (aOR 0.55, 95% CI 0.53 - 0.58). However, they showed increased use of mechanical ventilation (aOR 1.57, 95% CI 1.52 - 1.63). Conclusion: In conclusion, obese hypertensive emergency patients showed reduced in-hospital mortality, vasopressor use, mechanical circulatory support, and hemodialysis initiation, but increased mechanical ventilation use compared to non-obese counterparts. More comprehensive studies are required to comprehend the obesity paradox's impact on such patients, helping to unearth underlying factors, and thereby enhancing patient care strategies.