Effect of Antihypertensive Treatment on Hypotension, Mortality and Length of Stay in Orthopedic Trauma and First Detected High Blood Pressure Adults in a Large Urban Hospital: A Retrospective Cohort Study

Trauma is a frequent cause of hospital admission in adults, and while arterial hypertension is common in the general population, reactive hypertension associated with trauma remains poorly studied from a therapeutic perspective. This retrospective cohort study aimed to estimate the impact of antihypertensive treatment on hypotension occurrence, in‐hospital mortality, and length of stay in patients with musculoskeletal trauma. We analyzed data from a high‐complexity center in Colombia between 2020 and 2024, including adults over 18 years with musculoskeletal trauma who had no previously known hypertension but presented two blood pressure readings >140/90 mm Hg during hospitalization. Patients were categorized into those receiving antihypertensive treatment versus no prescription. Primary outcomes were assessed using logistic, linear, and time‐to‐event regression models for hypotension requiring medical intervention, in‐hospital death, and length of stay. Among 712 patients analyzed, most were young men (77% male, mean age 35 years) with few comorbidities (obesity 6.2%, diabetes 4.6%). Sixty percent had open fractures requiring surgical management. Antihypertensive drug exposure was significantly associated with hypotension (OR 11.9, 95% CI 5.69–26.4) but showed no significant association with in‐hospital death (OR 5.18, 95% CI 0.79–39.6), length of stay (1.5 days, 95% CI −0.1 to 3.1), or time‐to‐discharge alive (HR 0.79, 95% CI 0.59–1.06). Our findings suggest that treating reactive hypertension in hospitalized musculoskeletal trauma patients may increase hypotension risk without improving mortality or length of stay outcomes.