Key result
Hypertensive retinopathy is linked to ~3.8-fold higher odds of acute HMOD.
Why the study?
Severe hypertension is a common cause of ED visits associated with adverse cardiovascular outcomes, and identifying clinical factors associated with acute hypertension-mediated organ damage may improve risk stratification.
Cohort (n=881)
Yes
Answers are grounded in this paper and cite their sources.
In patients presenting to the emergency department with severe hypertension, elevated admission blood pressure, chronic kidney disease, hypertensive retinopathy, and current smoking are independently associated with acute hypertension-mediated organ damage and can aid in risk stratification.
BACKGROUND: Severe hypertension is a common reason for emergency department (ED) visits and is associated with adverse cardiovascular outcomes. Identifying factors associated with acute hypertension-mediated organ damage (HMOD) may improve risk stratification. METHODS: A large retrospective cohort study across four hospitals in Qatar (January 2015-January 2020). Adults presenting to the ED with severe hypertension (systolic blood pressure [SBP] ≥ 180 mmHg and/or diastolic blood pressure [DBP] ≥ 110 mmHg) were included. In a cross-sectional primary analysis, the outcome was hypertensive emergency, defined as acute HMOD present at the index presentation, and univariable and multivariable logistic regression identified factors independently associated with acute HMOD at presentation. A separate exploratory longitudinal secondary analysis described cardiovascular, cerebrovascular, and renal complications over three years of follow-up using descriptive statistics was conducted. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow test. RESULTS: Of 881 patients (median age 50 years [IQR 43-57]; 68.8% male), 94.7% had severe asymptomatic hypertension and 5.3% presented with hypertensive emergency. Independent factors associated with acute HMOD were higher admission SBP (adjusted odds ratio [aOR] 1.016, 95% CI 1.000-1.033), higher DBP (aOR 1.027, 95% CI 1.006-1.049), chronic kidney disease (aOR 2.38, 95% CI 1.02-5.57), hypertensive retinopathy (aOR 3.82, 95% CI 1.14-12.83), and current smoking (aOR 2.83, 95% CI 1.32-6.06). The model showed good discrimination (AUC 0.77) and adequate calibration. Kidney disease progression was the most common follow-up complication. CONCLUSIONS: Elevated admission blood pressure, chronic kidney disease, hypertensive retinopathy, and current smoking were independently associated with acute HMOD. These readily identifiable factors may support ED risk stratification in patients with severe hypertension.
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Barjas et al. (2026) conducted a cohort in Severe hypertension in the emergency department (n=881). Clinical risk factors (elevated admission SBP/DBP, chronic kidney disease, hypertensive retinopathy, current smoking) vs. Absence of risk factors / severe asymptomatic hypertension was evaluated on Hypertensive emergency (acute hypertension-mediated organ damage [HMOD] at index presentation) (OR 3.82, 95% CI 1.14-12.83). Hypertensive retinopathy, smoking, CKD, and higher BP were independently associated with acute HMOD.
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