Revealing Sex Differences in Hypertensive Urgency Management: Insights From a Tertiary Hospital

Sex differences in hypertensive urgencies (HUs) remain poorly characterized in emergency department (ED) settings. We conducted a retrospective observational study of adult ED visits for hypertensive urgency at a tertiary hospital in Spain between 2018 and 2022, excluding hypertensive emergencies. Sex differences in ED-based incidence, clinical presentation, blood pressure (BP) trajectories, acute management, and ED outcomes were assessed using multivariable regression models with correction for multiple testing. Among 2769 patients with HUs, women accounted for most cases and had a higher ED-based incidence than men. Women were older and more frequently reported headache or dizziness, whereas men more often presented with dyspnea or chest pain. Systolic BP trajectories during ED stay were similar between sexes, while diastolic BP remained higher in women. No clinically relevant sex differences were observed in acute pharmacological management after multiple-testing correction. Marked BP reductions frequently occurred during ED stay without pharmacologic intervention and were comparable between sexes. Overall, hypertensive urgencies showed relevant sex differences in incidence and clinical presentation, while blood pressure often declined even in the absence of acute pharmacological treatment, with limited differences in acute management or short-term BP response between women and men.