Long-term risk of adverse events in patients discharged alive after hospitalization for hypertensive crisis.

Abstract

Objective: To evaluate the long-term clinical course of patients presenting with hypertensive crisis discharged alive from hospital.

Methods: Retrospective study utilizing TriNetX. Based on the ICD-10-CM codes recorded between 2000 and 2022, patients with hypertensive crisis were subdivided into hypertensive urgencies (HU) and hypertensive emergencies (HE). In those with HE, the type of target organ damage was reported, i.e. central nervous system (ischemic or haemorrhagic stroke and hypertensive encephalopathy), cardiovascular (myocardial infarction (MI), heart failure (HF), aorta dissection (AD)), or renal (acute kidney failure). Primary outcomes were the one-year risks of all-cause death, and major cardiovascular events (MACE: MI, stroke, cardiac arrest, AD, and HF). Secondary outcomes were the risks for each type of MACE and the incident risk of Atrial Fibrillation (AF). Cox regression analysis after propensity score matching (PSM) 1 : 1 was used to produce hazard ratios (HRs) and 95% Confidence Intervals (95%CIs).

Results: Overall, we identified 27 721 patients with HE (age 62.4 ± 15.7, 46.3% females) and 23 478 patients with HU (age 63.4 ± 17.3, 55.8% females). After PSM, patients with HE showed a higher risk of all-cause death [hazard ratio (HR), 1.33, 95% confidence internal (CI) 1.24-1.44] and MACE (HR 4.00, 95% CI 3.79-4.22), vs. those with HU. Of the secondary outcomes, patients with HE had increased risks of MI, stroke, cardiac arrest, AD, acute HF, AD and incident AF. All the different types of organ involvement were associated with similar long-term risks of adverse events. During follow-up, 4% of patients with HU progressed to HE. Young age, female sex, Black or Asian ethnicity, smoking, secondary hypertension, diabetes and chronic kidney disease were identified as the main risk factors.

Conclusion: Patients with HE have a high long-term risk of all-cause death, MACE and incident AF. Preventing the onset of target organ damage in patients with hypertensive crisis is crucial to mitigate their long-term risk of adverse events.