Results:

Of 1,299,019 unique patient office visits, 4.8% had a hypertensive urgency and 58,535 were included. Of the 426 patients with hypertensive urgency, 0.7% were referred to the hospital, of whom 39 were admitted directly. Mean (standard deviation) age was 63.1 (15.4) years, 57.7% were women, and 76.0% white. Mean sBP was 182.5 (16.6) mm Hg with 10% ≥200 mm Hg, and mean dBP 96.4 (15.8) mm Hg with 5.7% ≥120 mm Hg. The mean BP of those referred to the hospital was 16/11 mm Hg higher than that of patients sent home (p < 0.001). The 852 patients sent home were compared with the 426 patients referred to the hospital. A total of 496 patients experienced major adverse cardiac events (MACE) within 6 months (205 episodes of acute coronary syndrome and 301 episodes of stroke or transient ischemic attack). The rate of MACE within 7 days, 8-30 days (1 month), and 6 months was low (<1%) in both groups. Patients sent home were more likely to have uncontrolled hypertension at 1 month (735 of 852 [86.3%] vs. 349 of 426 [81.9%]; p = 0.04), but not at 6 months (393 of 608 [64.6%] vs. 213 of 320 [66.6%]; p = 0.56). Patients sent home had lower hospital admission rates at 7 days.