Hypertensive crises are more frequent in older women than men but men with hypertensive crisis may have a worse long-term prognosis compared to women, highlighting the need for targeted post-discharge monitoring strategies in this subgroup.
Key Findings
Results
Hypertensive crisis accounted for 0.73% of ED visits among older patients, with women experiencing significantly higher rates than men.
Overall relative frequency was 0.73% (95%CI 0.63-0.84) of ED visits among patients aged 65 years and older
Frequency was 0.56% (95%CI 0.44-0.72) in men and 0.87% (95%CI 0.73-1.04) in women
Odds ratio for men versus women was 0.64 (95%CI 0.47-0.87), indicating significantly lower risk in men
186 cases of hypertensive crisis were identified among 25,557 patients in the EDEN cohort
The cohort was drawn from 52 Spanish public hospitals covering 19.3% of the Spanish population during a 1-week recruitment period
Results
The annual rate of hypertensive crisis in the Spanish older population was estimated at 429 cases per 100,000 inhabitants, with higher rates in women.
Overall annual rate was 429 cases per 100,000 inhabitants (95%CI 371-493)
Rate was 341 per 100,000 (95%CI 267-436) in men and 493 per 100,000 (95%CI 413-590) in women
Odds ratio for men was 0.69 (95%CI 0.51-0.94), confirming significantly lower incidence in men
Estimations of annual incidence were made in general and stratified by patient age
Results
Patients with hypertensive crisis had better baseline health status than other older ED patients, though cardiovascular comorbidity was frequent.
Previously known hypertension was present in 88.2% of patients with hypertensive crisis
22% of patients had additional acute diagnoses on top of the hypertensive crisis
Patients with hypertensive crisis demonstrated better baseline health status compared to the rest of older patients attending the ED
Cardiovascular comorbidity was described as frequent in this population
Results
Acute hospitalization was required in 7.5% of hypertensive crisis cases, with low in-hospital mortality.
Hospitalization was needed in 7.5% of cases
Only 0.5% of patients required intensive care unit admission
In-hospital mortality was observed in 2 cases, representing 1.1% of patients
These figures suggest that the acute phase of hypertensive crisis was generally managed successfully at the ED level
Results
Combined adverse events at one year post-discharge occurred in 57.9% of patients overall, with men experiencing significantly worse long-term outcomes than women.
Combined adverse events (revisit to ED, hospitalization, or death) at 1 year occurred in 57.9% of all patients
One-year combined adverse event rate was 65.6% in men compared to 52.5% in women
Adjusted hazard ratio for men versus women was 1.61 (95%CI 1.01-2.57), indicating significantly worse long-term prognosis in men
This finding persisted after adjustment, suggesting it is not explained by baseline demographic or clinical differences alone
Conclusions
Despite women having higher frequency and worse baseline profile of hypertensive crisis, men demonstrated worse long-term prognosis after the episode.
Women had higher frequency of hypertensive crisis both in relative ED visit frequency and annual population rate
Women were described as presenting a worse profile at baseline and higher severity than men at the time of the crisis
Despite this, men had a significantly higher 1-year combined adverse event rate (65.6% vs. 52.5%) with an adjusted HR of 1.61 (1.01-2.57)
Authors conclude this highlights the need for targeted post-discharge monitoring strategies in older men with hypertensive crisis
What This Means
This research suggests that among older adults (aged 65 and above) visiting emergency departments in Spain, hypertensive crises — dangerously high blood pressure episodes — are relatively uncommon, accounting for less than 1% of all emergency visits. However, older women experience these episodes at a notably higher rate than older men, both in terms of emergency visits and estimated annual cases in the general population. Nearly 9 in 10 patients with a hypertensive crisis already had a known diagnosis of high blood pressure, and about 1 in 5 had an additional acute medical problem occurring at the same time.
While most patients were managed without hospitalization and in-hospital deaths were rare, the longer-term picture was more concerning. Over the year following their emergency visit, nearly 6 in 10 patients experienced a serious adverse event such as a return trip to the emergency department, a hospitalization, or death. Strikingly, men fared considerably worse than women in this longer-term follow-up, with about 66% of men experiencing such events compared to about 53% of women — a difference that remained significant even after accounting for other health factors.
This research suggests that while hypertensive crises in older adults may appear manageable in the short term, the one-year outlook is poor for a large proportion of patients. The unexpected finding that older men — despite having lower rates of hypertensive crisis — have worse long-term outcomes than women points to a potential need for more intensive follow-up care specifically targeting older male patients after they are discharged from the emergency department following a hypertensive crisis.
Ò. Miró, A. García-Martínez, S. Aguiló, J. Parissis, E. Polyzogopoulou, P. Llorens, et al.. (2026). Hypertensive crisis in the elderly: epidemiological, clinical and outcome: EDEN-47 study.. Gerontology. https://doi.org/10.1159/000553140