Hypertensive Crisis-Related Hospitalizations and Subsequent Major Adverse Cardiac Events in Young Adults with Cannabis Use Disorder: A Nationwide Analysis

• Authors: Rupak Desai, Atlanta VA Medical Center; Akhil Jain, Mercy Catholic Medical Center; Waleed Sultan, Conemaugh Memorial Medical Center; Zainab Gandhi, Geisinger Wyoming Valley Medical Center; Athul Rj Raju, Karuna Medical College; Vivek Joseph Varughese, Government Medical College; Geethu Jnaneswaran, SUT Academy of Medical Sciences; Charu Agarwal, Sri Siddhartha Medical College; Bisharah Rizvi, Saint Agnes Medical Center; Zeeshan Mansuri, Harvard Medical School; Puneet Gupta, Baptist Health Deaconess Madisonville; Gautam Kumar, Emory University; Rajesh Sachdeva, Emory University
• Journal Title: MEDICINA-LITHUANIA
• Volume: Volume 58, Number 10
• Publisher: MDPI | 2022-10-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/medicina58101465
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; cannabis; marijuana; hypertension; hypertensive crisis; hypertensive emergency; in-hospital mortality; young; BLOOD-PRESSURE; MARIJUANA; ASSOCIATION; SMOKING

Abstract

Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18–44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015–December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06–1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01–1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55–12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38–2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02–2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.