Discharge Blood Pressure and Long-Term Cardiovascular Risk Among Emergency Department Patients With Uncontrolled Hypertension

Hypertension is a leading cause of cardiovascular morbidity and is frequently identified during emergency department (ED) visits. Many patients are discharged with uncontrolled blood pressure (BP), yet long-term cardiovascular risk associated with discharge BP remains unclear. We examined the relationship between discharge BP stage and long-term risk of major adverse cardiovascular events (MACE) among ED patients with uncontrolled hypertension over a five-year follow-up period.

We conducted a retrospective cohort study of adults (≥18 years) discharged from six urban EDs between 2017 and 2023 with uncontrolled hypertension, classified according to the 2025 American College of Cardiology/American Heart Association BP guidelines. Patients with more than 300 ED visits or a major adverse cardiovascular event (MACE) diagnosis at the index visit were excluded. The primary outcome was MACE—comprising ischemic heart disease, cerebrovascular disease, heart failure, aortic catastrophe, or hypertensive encephalopathy—identified using International Classification of Diseases, 10th Revision codes within five years of the index visit. Cox proportional hazards models estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for time to first MACE, adjusting for demographic factors, ED acuity, hospital admission, and comorbidity burden.

Among 63,270 patients (median age 55 years; 53.8% female), 1,802 (2.9%) experienced a MACE during follow-up. Compared with normal BP, elevated and Stage 1 BP were not significantly associated with MACE. In contrast, Stage 2 hypertension (adjusted HR 1.19, 95% CI 1.11–1.28) and Stage 3 hypertension (adjusted HR 1.86, 95% CI 1.52–2.27) were independently associated with higher risk. Kaplan–Meier analyses demonstrated progressively shorter time to MACE with increasing BP stage (log-rank p

Among ED patients discharged with uncontrolled hypertension, higher BP stage was assoAmong ED patients discharged with uncontrolled hypertension, higher BP stage was associated with a graded increase in long-term MACE risk over five years. These findings suggest that discharge BP provides important prognostic information and highlight the need for structured ED discharge pathways and timely outpatient follow-up for patients with uncontrolled hypertension.