Abstract FR430: Real-World Analysis of Nicardipine vs. Nitroglycerin for Hypertensive Urgency or Emergency

Introduction: Hypertensive urgency and emergency are critical conditions requiring inpatient care and IV antihypertensives. Common options include nitroglycerin and nicardipine, with selection often based on clinician preference, institutional protocols, or availability. This study compares outcomes between these agents in managing hypertensive crises. Methods: This retrospective cohort study used TriNetX global data from Jan 2007–May 2025, including adults ≥18 years. After propensity matching, both cohorts had 45,652 patients. Cohort 1 included patients with hypertensive urgency/emergency treated with nitroglycerin but not nicardipine; Cohort 2 received nicardipine but not nitroglycerin. Mean age was 62; 49% were male, 47% female. Risk ratios (RR), hazard ratios (HR), 95% confidence intervals, and p-values were calculated. Kaplan-Meier survival analysis was used to assess outcomes. Results: Cohort 1 had lower all-cause mortality (11.8%) vs. cohort 2 (18.5%) RR 0.637, 95% CI 0.617–0.657; HR 0.543, 95% CI 0.525–0.562; p<0.0001. However, cohort 1 had a higher AMI rate (21.37% vs. 6.97%) RR 3.066; HR 3.015; p<0.0001 and higher cardiogenic shock (1.72% vs. 0.75%) RR 2.289; HR 1.955; p=0.0538. Acute kidney failure occurred slightly more in cohort 1 (27.6% vs. 26.7%) RR 1.033; HR 0.891; p=0.0027. Cerebral infarction was significantly lower in cohort 1 (10.7%) than cohort 2 (25.4%) RR 0.422; HR 0.338; p<0.0001. Conclusion: Nitroglycerin use was associated with lower mortality and fewer cerebral infarctions compared to nicardipine, possibly due to less impact on cerebral perfusion. However, nitroglycerin was linked to increased risk of AMI and cardiogenic shock, likely related to reflex tachycardia and its venodilatory profile. A modestly higher rate of acute kidney injury was also noted. These findings highlight important safety and efficacy considerations when selecting antihypertensive therapy for hypertensive crises.