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Cardiological hypertensive emergencies: Real word data compared to guidelines indications

Filippo Brucato1, Chiara Tognola2, Lorenzo De Censi1

  • 1School of Medicine and surgery, University of Milano-Bicocca, Milan, Italy.

European Journal of Internal Medicine
|June 10, 2026
PubMed

Insights

Cardiological Hypertensive Emergencies (CHE) management shows a persistent gap between guidelines and practice. Lower target achievement in 2019 indicates incomplete adoption of aggressive blood pressure goals in emergency care.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Hypertension Management

Background:

  • Cardiological Hypertensive Emergencies (CHE) involve severely high blood pressure with acute cardiac damage.
  • Evaluating CHE prevalence, clinical features, and real-world blood pressure management is crucial.

Purpose of the Study:

  • To assess the prevalence, clinical features, and blood pressure management of CHE.
  • To compare emergency department (ED) practice adherence to guidelines before and after 2017.

Main Methods:

  • Retrospective analysis of adult patients with severe hypertension and cardiac damage in 2017 and 2019.
  • Defined target achievement based on SBP reduction (2017) and specific BP thresholds (2019).

Main Results:

  • 282 CHE cases analyzed, representing half of all hypertensive emergencies.
  • Nitroglycerin was the primary IV therapy; short-acting nifedipine use decreased.
  • Lower target achievement in 2019 due to more stringent BP goals.

Conclusions:

  • A gap persists between CHE guideline recommendations and clinical practice.
  • Reduced target achievement in 2019 suggests incomplete adoption of aggressive BP targets.
  • Potential reasons include hypoperfusion concerns, limited guideline dissemination, or documentation differences.
Abstract

Keywords:
Acute coronary syndromeAcute heart failureCardiological hypertensive emergencyEmergency departmentHypertensive emergency

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