The rate of patients presenting with hypertensive urgency in an outpatient setting is common; however, the rate of major adverse cardiovascular events (MACE) in asymptomatic patients is very low. This according to a study of 2,199,019 unique patient office visits, 58,535 of which were included in the study (mean age 63.1 years; 57.7% women; 76% white). The goal was to describe the prevalence of hypertensive urgency and the characteristics and short-term outcomes, and to determine whether referral to the hospital is associated with better outcomes than outpatient management. Researchers found:

• Mean BMI was 31.1; mean systolic blood pressure, 182.5 mm/Hg, and mean diastolic blood pressure, 96.4 mm/Hg.

• There was no significant difference in MACE at 7 days, 8 to 30 days, or 6 months when comparing the 852 patients sent home with the 426 patients referred to the hospital.

• Patients sent home were more likely to have uncontrolled hypertension at 1 month but not at 6 months.

• Patients sent home had lower hospital admission rates at 7 days and at 8 to 30 days.

Citation: Patel KK, Young L, Howell EH, et al. Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting. [Published online ahead of print June 13, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.1509.

Commentary: This study fills an important void in the literature about the relative merits of inpatient vs outpatient management of hypertensive urgencies, defined as hypertension presenting with systolic BP >180 or diastolic BP >110. Since vascular damage from high blood pressure accumulates over time, there is not really a good reason to believe that acute treatment of asymptomatic hypertensive urgencies would yield a better outcome than appropriate outpatient management, yet many clinicians send hypertensive urgencies to the ER. This study gives strong support to a logical, more cost-effective and likely lower-risk approach of appropriate outpatient management for patients presenting with hypertensive urgencies. —Neil Skolnik, MD