Clinical Question

How urgently should we aim to control hypertensive urgency?

Bottom Line

It seems that rapid treatment of patients with hypertensive urgency is unsuccessful and unnecessary. In this study of almost 60,000 patients, 80% did not have controlled blood pressure (less than 140/90 mm Hg) after one month of treatment, including patients who were hospitalized. On the other hand, the risk of a major cardiovascular event was also low: one in 1,000 over the next seven days. (Level of Evidence = 2b)

Synopsis

These authors identified all patients in a single health care system (N = 58,535) who presented to an office or emergency department with a blood pressure of at least 180 mm Hg systolic and/or 110 mm Hg diastolic. Most of the patients in the analysis just met these minimums; only 10.2% had a systolic pressure of 200 mm Hg or higher and 5.7% had a diastolic pressure of 120 mm Hg or higher. The mean age of the patients was 63.1 years, 57.7% were women, and 76% were white. A small proportion (0.7%) were hospitalized for blood pressure management; however, one-half of these patients had pressures of at least 200 mm Hg systolic or at least 120 mm Hg diastolic.

Regardless of treatment or place of treatment, the likelihood of blood pressure control and the likelihood of adverse effects were low. At one month, less than 15% of patients had controlled blood pressure; at six months, less than 40% had controlled blood pressure. Even so, the likelihood of a major adverse cardiovascular event was low in the next seven days (0.1%), at eight to 30 days (0.2%), or within six months (0.9%). Hospitalization was not associated with a decrease in the risk of adverse outcomes.

Study design: Cohort (retrospective)

Funding source: Self-funded or unfunded

Setting: Outpatient (any)

Reference: PatelKKYoungLHowellEHet alCharacteristics and outcomes of patients presenting with hypertensive urgency in the office setting. JAMA Intern Med2016;176(7):981–988.