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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
Summary
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.
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