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

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.

Association of Cannabis Use Disorder with Major Adverse Cardiac and Cerebrovascular Events in Older Non-Tobacco Users: A Population-Based Analysis

“…However, this population-based cross-sectional study pooling data from 2008-2017 concluded that legalization of cannabis was not associated with use disorder among blacks [21]. The mechanism of the increased rate of stroke in our study among a CUD cohort (5.2% vs. 4.8%, p = 0.002) who do not smoke tobacco remains to be established; however, it could be secondary to higher risk of hypertensive emergencies in older patients and arrhythmias [22,23].…”

Hypertensive crisis: diagnosis, presentation, and treatment

“…Other recently highlighted risk factors include the outpatient use of NSAIDs, which are a known contributor to elevated BP, with one study finding 53% of patients with HTN-C had recently used NSAIDs [14]. Cannabis use disorder has also been associated with an increased incidence of hospitalization for HTN-C [15]. Finally, obstructive sleep apnea (OSA), a leading cause of secondary hypertension, was found in 58% of patients admitted for HTN-C who were tested for OSA [16].…”

Adverse Cardiovascular Outcomes in Young Cannabis Users: A Nationwide Analysis

“…While this may be reassuring, recent research describes detrimental effects of cannabis use. Two separate studies, one using a national inpatient sample from 2007-2014 and the other from 2015-2017, demonstrated statistically significant trends in hypertensive emergency-related admissions in cannabis use disorder despite adjusting for comorbid conditions [4,5]. Cannabis use has also been associated with smoking, and odds of cannabis users using cocaine have been significant [6].…”