Abstract 4362969: Sex-Based Differences in 30-Day Outcomes After Hypertensive Emergencies: A Propensity-Matched National Cohort Study

Background: Hypertensive emergencies are associated with acute end-organ damage and require urgent management. Emerging evidence suggests sex-based differences in cardiovascular pathophysiology and care delivery, but their impact on short-term outcomes following hypertensive crises remains unclear. Methods: Using the TriNetX US Collaborative Network, we identified adults (≥18 years) diagnosed with hypertensive emergencies (ICD-10: I16.0–I16.1) between 2000 and 2024. After 1:1 propensity score matching for 29 demographic, clinical, and treatment variables, 204,784 males and 204,784 females were included. Outcomes were assessed from day 1 to day 30 post-index. Primary outcomes included mortality, acute kidney injury (AKI), myocardial infarction (MI), intracerebral hemorrhage (ICH), hypertensive encephalopathy, non-ST elevation MI (NSTEMI), pulmonary edema, aortic dissection, and resource utilization (critical care, IV antihypertensives, arterial catheterization, and renal replacement therapy [RRT]). Results: Males had higher 30-day risks of mortality (2.8% vs. 2.0%; OR 1.41, 95% CI 1.36–1.47), AKI (3.3% vs. 2.3%; OR 1.46, 95% CI 1.40–1.53), MI (1.5% vs. 1.1%; OR 1.44, 95% CI 1.36–1.53), NSTEMI (4.7% vs. 3.5%; OR 1.37, 95% CI 1.33–1.41), ICH (0.4% vs. 0.3%; OR 1.31, 95% CI 1.18–1.46), and aortic dissection (0.4% vs. 0.2%; OR 1.92, 95% CI 1.69–2.17). Critical care use (10.1% vs. 7.8%; OR 1.34, 95% CI 1.31–1.36), IV antihypertensive use (32.6% vs. 29.2%; OR 1.17, 95% CI 1.16–1.19), and RRT (0.5% vs. 0.3%; OR 1.54, 95% CI 1.39–1.70) were also higher in males. Females had a higher rate of hypertensive encephalopathy (0.2% vs. 0.2%; OR 0.86, 95% CI 0.75–0.99; p =0.035). Conclusions: Despite matched clinical profiles, males with hypertensive emergencies exhibited significantly worse short-term outcomes, including higher rates of mortality and cardiovascular complications. These findings underscore the need for sex-specific approaches in acute hypertension management and call for further research into underlying biological and care delivery mechanisms.