Analysis of office and out-of-office blood pressure levels in adult outpatients with hypertensive urgency: a cross-sectional, retrospective study in a hypertension excellence center

Introduction: Hypertensive urgency (HU) is a clinical condition characterized by rapid office blood pressure (BP) elevation in the absence of hypertension-mediated organ damage (HMOD). Aim: To evaluate out-of-office BP levels and predictors of HU in adult outpatients with stage 3 hypertension. Methods: We included patients who were consecutively referred for office and out-of-office BP assessment. All patients underwent BP measurements using a validated, oscillometric device (Mobil-O-Graph PWA Monitor, I.E.M. GmbH, Stolberg, Germany). Patients were stratified into two groups: grade 3 hypertension (either systolic BP ≥180 mmHg or diastolic BP ≥110 mmHg); HU (both systolic BP ≥180 and diastolic BP ≥110 mmHg). Results: We identified 828 adult outpatients (42.6% women, age 56.5 ± 13.6 years, BMI 27.5 ± 5.2 kg/m2, 55.2% on therapy), among whom 655 (79.1%) had grade 3 hypertension and 173 (20.9%) had HU. HU patients consistently showed significantly higher home (157.0 ± 25.3 vs. 146.9 ± 20.4 mmHg), 24-h (155.6 ± 18.3 vs. 143.2 ± 13.7 mmHg), daytime (160.5 ± 18.2 vs. 147.7 ± 13.9 mmHg), and night-time (143.2 ± 20.1 vs. 131.0 ± 16.1 mmHg) systolic BP values than those with stage 3 hypertension, even when treated. Diastolic BP levels were also higher at all BP measurements. Female sex [odds ratio (OR) 0.53 (95% confidence interval (CI) 0.32-0.86); P = 0.010], age >50 years [OR 2.57 (95% CI 1.48-4.69); P = 0.001], smoking [2.03 (1.21-3.37); P = 0.006], home diastolic [OR 1.02 (95% CI 1.00-1.04); P = 0.013] and daytime systolic [OR 1.04 (95% CI 1.03-1.06); P < 0.001] BP were independent predictors of having HU at multivariate analysis. Conclusions: HU outpatients showed persistently higher out-of-office BP levels than those with stage 3 hypertension, even when treated.