Key result
Hypertensive emergencies linked to ~71% higher in-hospital mortality than hypertensive urgencies.
Why the study?
Hypertensive crises frequently cause emergency department visits, but evidence regarding their prognosis is limited amid updated guidelines questioning traditional classifications.
Does the classification of hypertensive crisis (emergency vs urgency) and patient comorbidities predict in-hospital mortality in adults presenting to the emergency department?
Observational (n=7,439)
No
Does the classification of hypertensive crisis (emergency vs urgency) and patient comorbidities predict in-hospital mortality in adults presenting to the emergency department?
Absolute Event Rate: 1.2% vs 0.7%
p-value: p=0.016
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.
May refine ED mortality risk stratification; leaves open whether management should differ beyond age and comorbidities.
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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Preto et al. (2026) conducted an observational in Hypertensive crises (n=7,439). Hypertensive emergency vs. Hypertensive urgency was evaluated on In-hospital mortality (p=0.016). Hypertensive emergencies were associated with higher in-hospital mortality compared to hypertensive urgencies (1.2% vs 0.7%; p=0.016).
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