Kidney disease, hospitalized hypertension, and cardiovascular events: cause or consequence?

In this issue of Circulation, Szczech et al1 report selected results from the Studying the Treatment of Acute Hypertension (STAT) registry, a recently completed observational study whose goal is “to improve the understanding of the clinical condition of acute, severe hypertension . . . managed in a critical care setting and treated with intravenous antihypertensive therapy.”2 The STAT registry is sponsored by the Medicines Company, a publically traded entity focused on “advancing the treatment of critical care patients through the delivery of innovative, cost-effective medicines to the worldwide hospital marketplace.”3 The stated goal of the analyses presented was to “define the risk among patients with acute severe hypertension and acute kidney injury (AKI), and the risk associated with both AKI and chronic kidney disease (CKD) on cardiovascular outcomes and mortality.”1 Although the extensive array of analyses presented by Szczech et al highlights an important area of investigation, readers should be circumspect about the conclusions reached.