Outcomes of minority patients with very severe hypertension (>220/>120mmHg)

Richard A. Preston, Rafael Arciniegas, Stephane Degraff, Barry J Materson, Jeffrey Bernstein, David Afshartous

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives:Acute severe hypertension is a common problem among inner-city ethnic minority populations. Nevertheless, the effects of currently employed treatment regimens on blood pressure have not been determined in a clinical practice setting. We determined the SBP responses to acute antihypertensive drug protocols and the 2-year natural history of patients presenting with severe hypertension.Methods:Retrospective cohort investigation in consecutive patients with SBP at least 220mmHg and/or DBP at least 120mmHg during 3-month enrollment in 2014 with 2-year follow-up. Primary outcomes were SBP versus time for the first 5h of emergency treatment and 2-year follow-up including repeat visits, target organ events, and hospitalizations.Results:One hundred and fifty-six unique patients met criteria with 69% Black; 34% Hispanic; 56% had previous visits for severe hypertension; 31% had preexisting target injury. Acute management: Acute antihypertensive regimens resulted in grossly unpredictable and often exaggerated effects on SBP. Treatment acutely reduced SBP to less than 140mmHg in 30 of 159 patients. Clonidine reduced SBP to less than 140mmHg in 19/61. Two-year follow-up: We observed 389 repeat visits for severe hypertension, 99 new target events, and 76 hospitalizations accounting for 620 hospital days.Conclusion:Acute treatment of severe hypertension produced unpredictable and potentially dangerous responses in SBP. Two-year follow-up demonstrated extraordinary rates of recurrent visits, target organ events, and hospitalizations. Our findings indicate a need to develop effective management strategies to lower blood pressure safely and to prevent long-term consequences. Our findings may apply to other hospitals caring for ethnic minority populations.

Original languageEnglish (US)
Pages (from-to)415-425
Number of pages11
JournalJournal of hypertension
Issue number2
StatePublished - 2019


  • antihypertensive drugs
  • clonidine
  • hypertensive crisis
  • hypertensive target organ injury
  • hypertensive urgency
  • severe hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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