Association between hypertensive urgencies and subsequent cardiovascular events in patients with hypertension

Objective To determine whether patients with hypertensive urgency have a higher risk for subsequent cardiovascular events compared with hypertensive patients without this event. Methods Overall, 384 patients with hypertensive urgency and 295 control patients were followed up for at least 2 years. Hypertensive urgency was defined as a systolic blood pressure above 220 mmHg and/ or a diastolic blood pressure above 120mmHg without any evidence of acute end-organ damage. The control group consisted of patients admitted to the emergency department with a systolic blood pressure between 135 to 180 mmHg and a diastolic blood pressure between 85-110mmHg. The number of cardiovascular events defined as acute coronary syndrome, acute stroke, atrial fibrillation, acute left ventricular failure and aortic aneurysm were consecutively analyzed during follow-up. The median follow-up time was 4.2 years ( interquartile range 2.9-5.7 years). Twenty-six patients of the urgency group and 23 patients of the control group were lost for follow-up. Results Overall, 117 (17%) patients had nonfatal clinical cardiovascular events and 13 had (2%) fatal cardiovascular events. The frequency of cardiovascular events was significantly higher in patients with hypertensive urgencies ( 88 vs. 42; P = 0.005). The Cox regression analysis identified age ( P < 0.001) and hypertensive urgencies ( P = 0.035) as independent predictors for subsequent cardiovascular events. Conclusions Hypertensive urgencies are associated with an increased risk for subsequent cardiovascular events in patients with arterial hypertension.