What is the clinical evidence from this study?

Study design: Observational. Population: Hypertensive crises (n=7439). Intervention: Hypertensive emergency vs. Hypertensive urgency. Primary outcome: In-hospital mortality (p=0.016).

What question did this study set out to answer?

This research aims to evaluate the in-hospital mortality rates of patients experiencing hypertensive crises and identify predictors of mortality.

June 3, 2026

In-Hospital Mortality of Hypertensive Crises: A Tertiary Center Study

Key Result

Hypertensive emergencies were associated with higher in-hospital mortality compared to hypertensive urgencies (1.2% vs 0.7%; p=0.016).

Key Points

This research aims to evaluate the in-hospital mortality rates of patients experiencing hypertensive crises and identify predictors of mortality.
Retrospective observational study of adult patients in a tertiary cardiology ED from January 2021 to December 2024.
Hypertensive crises defined by blood pressure readings; classified using ICD-10 codes.
Multivariable logistic regression used to analyze predictors of mortality.
Among 7,439 patients with hypertensive crises, overall in-hospital mortality was 0.9%.
Mortality was higher in hypertensive emergencies (1.2%) compared to urgencies (0.7%), p=0.016.
Independent mortality predictors included increasing age (OR 1.06 per year) and prior stroke (OR 4.33).

Study Design

Type

Observational (n=7,439)

Multicenter

Structured PICO

Does the classification of hypertensive crisis (emergency vs urgency) and patient comorbidities predict in-hospital mortality in adults presenting to the emergency department?

Population

7,439 adult patients with hypertensive crises admitted to a tertiary cardiology emergency department between January 2021 and December 2024.

Exposure

Hypertensive emergency classification

Comparator

Hypertensive urgency classification

Outcome

In-hospital mortality, hospitalization, and ICU admissionhard clinical

In-hospital mortality for hypertensive crises is low (0.9%) and is primarily driven by age and comorbidities rather than the absolute severity of blood pressure elevation.

Main Result

Absolute Event Rate: 1.2% vs 0.7%

p-value: p=0.016

Abstract

Objective: Hypertensive crises (HC) are frequent causes of emergency department (ED) visits, yet evidence regarding their prognosis, particularly mortality, is limited. Recent guideline updates have questioned traditional classifications of hypertensive emergencies and urgencies, emphasizing the risk of diagnostic misclassification and overtreatment. Design and method: We conducted a retrospective observational study including all adult patients (>=18 years) admitted to a tertiary cardiology ED between January 2021 and December 2024. HC was defined as systolic blood pressure >180 mmHg and/or diastolic blood pressure >110 mmHg at triage. Cases were classified as hypertensive emergency or urgency according to ICD-10 codes recorded by physicians. Demographic characteristics, comorbidities, treatments including oral antihypertensives, intravenous vasodilators, anxiolytics, and analgesics, and outcomes were extracted from electronic health records. Primary outcomes were in-hospital mortality, hospitalization, and ICU admission. Multivariable logistic regression identified independent predictors of mortality. Results: Among 119,147 ED visits, 7,439 (6.2%) met criteria for HC, including 2,931 (2.4%) classified as hypertensive emergencies and 4,508 (3.7%) as urgencies. Mean age was 64.9 +/- 13.7 years, and 55% were women. Overall in-hospital mortality was low (0.9%) but higher in emergencies compared with urgencies (1.2% vs 0.7%; p=0.016). Increasing age (OR 1.06 per year), prior stroke (OR 4.33), and active or former smoking were independent predictors of death. Conclusions: In a high-volume tertiary cardiac ED, hypertensive crises were common but associated with low in-hospital mortality. Severe blood pressure elevation alone poorly discriminated mortality risk, which was primarily driven by age and comorbid conditions rather than blood pressure values.

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