Outcomes after hypertensive crisis: Comparison between diabetics and nondiabetics

Abstract

To study the long-term cardiovascular and non-cardiovascular outcomes among patients admitted with hypertensive crisis. A total of 297 (145 diabetics, 152 nondiabetics) patients with hypertensive crisis were followed up for a median of 30 months. Fatal and nonfatal events were tracked. The traced events defined as hypertensive urgency, acute coronary syndrome, left ventricular failure, atrial fibrillation, cerebrovascular or renal failure were consecutively analyzed during the follow-up.Overall, 140 (47%) patients had nonfatal clinical events (115 diabetics and 25 nondiabetics); 37 (12%) patients had fatal clinical events (26 diabetics and 11 nondiabetics). The rate of fatal and nonfatal events was significantly higher in diabetics. The mean time of survival was 25.7 months, with the shortest periods for stroke and left ventricular failure. For nondiabetic participants, the mean time of survival was 31 months. Cox regression analysis identified diabetes mellitus, acute left ventricular failure, stroke and renal impairment as predictors of mortality. In conclusion, hypertensive crisis is associated with a markedly increased risk for subsequent cardiovascular morbidity and mortality, especially among diabetics who present with heart failure.