Clinical Profile and Outcome of Hypertensive Emergencies: A Prospective Observational Study

Hypertensive emergencies are among the most common life-threatening acute medical conditions encountered in clinical practice. They are characterized by a sudden, severe elevation of blood pressure (systolic ≥180 mmHg and/or diastolic ≥120 mmHg) in association with acute target organ damage, leading to significant short-term mortality and long-term morbidity. In low- and middle-income regions, delayed detection, poor treatment adherence, and limited health infrastructure amplify this burden. This prospective observational study aimed to evaluate the clinical profile, organ involvement, and in-hospital outcomes of patients admitted with hypertensive emergencies to a tertiary care centre in northern India.

We enrolled 300 consecutive patients aged ≥18 years who fulfilled the diagnostic criteria for hypertensive emergencies over two years (Oct 2022-Sep 2024) at the Government Medical College, Srinagar. Demographics, medical history, presenting symptoms, blood pressure trends, target organ damage, laboratory and imaging findings, treatment measures, and outcomes were recorded. Statistical analysis was performed using SPSS v29.0 and R software, with categorical variables compared using the chi-square or Fisher's exact test, and statistical significance set at p<0.05.

Of the 300 patients (58% men, 42% women), the predominant age group was 60-69 years (28%). Neurological involvement was the most frequent manifestation, with intracerebral haemorrhage and ischemic stroke occurring in 48% and 19% patients, respectively. Cardiac complications included left ventricular failure (15.7 %) and myocardial infarction (11.3 %). Fundoscopic changes indicative of hypertensive retinopathy were observed in 39% of the patients, and microalbuminuria was present in 28.3% of the patients. A significant proportion (72.3%) had known hypertension, although 42.4% reported poor treatment adherence. Serial monitoring revealed a consistent reduction in both systolic and diastolic pressures with prompt treatment initiation. Despite aggressive management, the in-hospital mortality rate was 21.7%, largely attributable to intracerebral hemorrhage.

This study underscores the high burden of neurological, cardiac, and renal complications in hypertensive emergencies, with intracerebral hemorrhage emerging as the most frequent manifestation, in contrast to Western patterns, where ischemic events predominate. These findings highlight the impact of delayed diagnosis, limited access to emergency care, and suboptimal BP control. The high prevalence of target organ damage reflects chronic, uncontrolled hypertension and predicts adverse outcomes. Strengthening community screening, ensuring effective treatment adherence, and improving acute care capacity are essential for reducing mortality and morbidity in resource-limited settings.

Hypertensive emergencies remain a public health challenge that requires timely recognition, aggressive management, and preventive strategies.