Cardiological hypertensive emergencies: Real word data compared to guidelines indications.

BACKGROUND

Cardiological Hypertensive Emergencies (CHE) are characterized by markedly elevated blood pressure (BP) values associated with acute cardiac hypertension-mediated organ damage (acute coronary syndrome, acute heart failure, acute pulmonary edema, or aortic dissection). This study aimed to evaluate the prevalence, clinical features and real-world BP management of CHE and to assess adherence to guideline recommendations by comparing ED practice before and after recent guideline release (2017 vs 2019).

METHODS

This single-center retrospective analysis included all adult patients admitted to the ED of Niguarda Hospital, Milan, during 2017 and 2019 with severely elevated BP (SBP ≥180 mmHg and/or DBP ≥120 mmHg) and acute cardiological organ damage. Target achievement was defined as ≥25% SBP reduction for 2017 and SBP <140 mmHg (<120 mmHg for aortic dissection) for 2019.

RESULTS

282 CHE were analysed representing nearly half of all hypertensive emergencies in both years. Nitroglycerin was the predominant intravenous therapy used. Short-acting nifedipine use strongly decrease from 2017 to 2019. Baseline BP values were 193.2/95.2 ± 14.2/17.4 mmHg and decreased significantly during the ED stay (∆ 37.4/17.1 vs 26.0/20.4 mmHg). The proportion of patients achieving guideline-defined targets was lower in 2019, reflecting the introduction of more stringent BP goals.

CONCLUSIONS

This real-world analysis demonstrates a persistent gap between guideline recommendations and clinical practice in the management of CHE. The reduced target achievement in 2019 suggests that the adoption of aggressive BP targets remains incomplete, potentially due to concerns regarding hypoperfusion, limited dissemination of guideline updates or differences in documentation.