Effect of Antihypertensive Treatment on Hypotension, Mortality and Length of Stay in Orthopedic Trauma and First Detected High Blood Pressure Adults in a Large Urban Hospital: A Retrospective Cohort Study

Trauma is a frequent cause of hospital admission in adults, and while arterial hypertension is common in the general population, reactive hypertension associated with trauma remains poorly studied from a therapeutic perspective. This retrospective cohort study aimed to estimate the impact of antihypertensive treatment on hypotension occurrence, in-hospital mortality, and length of stay in patients with musculoskeletal trauma. We analyzed data from a high-complexity center in Colombia between 2020 and 2024, including adults over 18 years with musculoskeletal trauma who had no previously known hypertension but presented two blood pressure readings >140/90 mm Hg during hospitalization. Patients were categorized into those receiving antihypertensive treatment versus no prescription. Primary outcomes were assessed using logistic, linear, and time-to-event regression models for hypotension requiring medical intervention, in-hospital death, and length of stay. Among 712 patients analyzed, most were young men (77% male, mean age 35 years) with few comorbidities (obesity 6.2%, diabetes 4.6%). Sixty percent had open fractures requiring surgical management. Antihypertensive drug exposure was significantly associated with hypotension (OR 11.9, 95% CI 5.69-26.4) but showed no significant association with in-hospital death (OR 5.18, 95% CI 0.79-39.6), length of stay (1.5 days, 95% CI -0.1 to 3.1), or time-to-discharge alive (HR 0.79, 95% CI 0.59-1.06). Our findings suggest that treating reactive hypertension in hospitalized musculoskeletal trauma patients may increase hypotension risk without improving mortality or length of stay outcomes.