Prevalence, clinical features and emergency department blood pressure management of hypertensive emergencies and uncontrolled hypertension: a retrospective multi-centre study

Q: What are the key findings of this study?

In patients presenting to the emergency department with severe hypertension, systolic blood pressure reduction was similar between those with hypertensive emergencies and uncontrolled hypertension.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hypertensive emergencies and uncontrolled hypertension (n=1838). Intervention: Hypertensive emergency vs. Uncontrolled hypertension. Primary outcome: Systolic blood pressure decrease in the emergency department (p=0.312).

Q: What does this research mean for the field?

Emergency department management of hypertensive emergencies and uncontrolled hypertension shows suboptimal adherence to clinical guidelines, with similar blood pressure reductions achieved in both conditions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Alessandro Maloberti; Giulia Capitoli; Tommaso Valobra; Paola Rebora; Nicolas Mavreas; Silvia Vergani; Valentina Giani; Chiara Tognola; Nicolò Capsoni; Michele Galasso; Lorenzo De Censi; Cecilia Ferretti; Andrea Sultana; G Peraro; Martina Morelli; Annalisa Giacalone; Ilaria Garofani; Filippo Galbiati; Michele Bombelli; Cristina Giannattasio

doi:10.1038/s41440-026-02788-1

Key result

ED blood pressure management achieves similar systolic reductions in hypertensive emergencies and uncontrolled hypertension.

P=0.312
n=1,838

Why the study?

Published data regarding the prevalence and clinical management of hypertensive emergencies and uncontrolled hypertension are very heterogeneous.

Key Points

To characterize patients with hypertensive emergencies (HE) and uncontrolled hypertension (UH), evaluate emergency department blood pressure management and guideline adherence, identify factors associated with organ damage, and assess impacts on in-hospital mortality.
Retrospective multicenter study across two centers (Niguarda Hospital - Milan and Pio XI Hospital - Desio) reviewing patients admitted to the emergency department with blood pressure ≥ 180/120 mmHg between 2017 and 2019 (N = 1838).
Patients were categorized into HE (with acute hypertension-mediated organ damage) or UH (without acute organ damage), and clinical characteristics, pharmacological management, and outcomes were compared.
Among 1838 patients admitted with BP ≥ 180/120 mmHg (0.95% of total admissions), 37.7% had HE and 62.3% had UH.
Systolic and diastolic blood pressure reductions were similar between groups: 40.6/16.9 ± 26.3/17.7 mmHg in HE versus 39.3/15.5 ± 22.4/16.0 mmHg in UH.
Antihypertensive therapy was administered to 60.6% of HE patients and 48.8% of UH patients (p < 0.001); intravenous furosemide (33.6%) and nitroglycerin (13.4%) were most common for HE, whereas oral short-acting nifedipine (11.6%) and intravenous clonidine (15.2%) were frequently used for UH.

Study Design

Type

Observational (n=1,838)

Multicenter

Yes

Structured PICO

P

Population

1,838 adult patients presenting to the emergency department with severe blood pressure elevation (≥180/120 mmHg), evaluated for clinical features and management of hypertensive emergencies versus uncontrolled hypertension.

O

Outcome

Blood pressure management in the Emergency Department, pharmacological treatment, adherence to guidelines, and variables associated with the presence of organ damage (hypertensive emergencies vs uncontrolled hypertension)

Main Result

Absolute Event Rate: 40.6% vs 39.3%

p-value: p=0.312

Limitations

Retrospective and cross-sectional design preventing calculation of incidence and long-term outcomes
Subjects were primarily selected on discharge diagnosis rather than initial BP values, risking underestimation
Missing data for the second ED BP values in 383 patients
Absence of systematic laboratory evaluation could have led to underestimation of some hypertension-mediated organ damage
Possible misclassification bias for untreated patients whose therapies were not registered in the ED
Inability to investigate discontinuation or poor adherence to antihypertensive therapy
Potential misclassification bias due to unrecorded therapies in the ED for surgical cases (e.g., hemorrhagic stroke, aortic dissection)

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Implication

In patients presenting to the emergency department with severe hypertension, adherence to guidelines for blood pressure management is suboptimal, with frequent under-treatment of stroke and overuse of short-acting nifedipine.

Abstract

Very heterogeneous data have been published concerning prevalence and clinical management of Hypertensive Emergencies (HE) and Uncontrolled Hypertension (UH). The aim of our study was to characterize HE and UH patients evaluating: (i) Blood Pressure (BP) management in Emergency Department (ED), the pharmacological treatment and its adherence to guidelines recommendation; (ii) variables associated with the presence of organ damage; and (iii), as an exploratory analysis, the impact of BP on in-hospital mortality. We performed a multicentre (Niguarda Hospital - Milan and Pio XI Hospital – Desio) retrospective study evaluating patients admitted to ED with BP values ≥ 180/120 mmHg during 2017 and 2019. 1838 patients were admitted to the ED with a BP ≥ 180/120 mmHg (0.95% of total admissions) of whom 37.7% were HE and the remaining (62.3%) were UH. The reduction in Systolic and Diastolic BP (SBP/DBP respectively) was similar in HE (40.6/16.9 ± 26.3/17.7 mmHg) and UH (39.3/15.5 ± 22.4/16.0 mmHg). The most used drugs were intravenous furosemide, nitroglycerin, clonidine and labetalol for HE. Age, smoking, heart failure, previous acute coronary syndrome, chronic kidney disease and diabetes mellitus present a positive association HEs while female sex and chronic anti-hypertensive therapies with 2 or more drugs results as protective variables. Finally, regarding the exploratory analysis, BP at ED admission and its management didn’t present significant association with in-hospital mortality. In conclusions, our study demonstrated that adherence to guidelines in the management of HE/UH could be further improved.

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Cite This Study

Maloberti et al. (2026) conducted an observational in Hypertensive emergencies and uncontrolled hypertension (n=1,838). Hypertensive emergency vs. Uncontrolled hypertension was evaluated on Systolic blood pressure decrease in the emergency department (p=0.312). In patients presenting to the emergency department with severe hypertension, systolic blood pressure reduction was similar between those with hypertensive emergencies and uncontrolled hypertension.

synapsesocial.com/papers/6a993643636c6408cfa7f31d https://doi.org/10.1038/s41440-026-02788-1

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Prevalence, clinical features and emergency department blood pressure management of hypertensive emergencies and uncontrolled hypertension: a retrospective multi-centre study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevalence, clinical features and emergency department blood pressure management of hypertensive emergencies and uncontrolled hypertension: a retrospective multi-centre study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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