LAUSR

Hypertensive emergencies (severely elevated blood pressure with evidence of acute, ongoing target-organ damage) are traditionally distinguished from “hypertensive urgencies” (if they really exist) by the need for prompt, but controlled, reduction in blood pressure in the former. The longer-term cardiovascular risk associated with these conditions has not been well characterized. A systematic review of the literature was therefore conducted, which identified 6 reports about subsequent death or cardiovascular hospitalization after successful treatment for either diagnosis ( J Hypertens . 2008; 26: 657; J Clin Hypertens . 2011; 13: 551; JAMA Intern Med . 2016; 176: 981; J Clin Hypertens . 2017; 19: 137; J Hypertens . 2021; 39: 2514; and Eur J Prev Cardiol . 2022; 29: 194). The pooled average annualized risk of death or cardiovascular hospitalization for patients with hypertensive emergencies was 26±8% (168 of 640, 4 reports); compared to 4±1% (76 of 2041, 5 reports) for hypertensive urgencies. Rates of the same outcome were 11±2% (8 of 70) among subjects randomized to placebo in the original Veterans Administration trial ( JAMA . 1967; 202: 1028), and 3±1% (182 of 6110 in two fairly recent trials in patients with less severe, but “high-risk” hypertension (LIFE: Lancet . 2002; 359: 995, VALUE: Lancet . 2004; 363: 2022). Despite moderate heterogeneity within the diagnostic groups, these data highlight the very high residual cardiovascular risk of people with successfully-treated hypertensive emergencies, compared to untreated Veterans with diastolic blood pressures between 115-129 mm Hg, both of which are much higher than people with hypertensive urgencies, or patients with hypertension and other cardiovascular risk factors.