Evidence map›Paper›PMID 41915559›Full record

Observational studyAnnals of the American Thoracic Society2026

Outcomes of patients with hypertensive emergency managed in intensive vs intermediate care settings: a multihospital retrospective cohort study.

Chad H Hochberg, Li Yan, M Elizabeth Card, Stephen A Berry, Daniel Brodie, Leo Rotello, Amirali Nader, Souvik Chatterjee, Sarina K Sahetya, Theodore J Iwashyna and 1 more

Abstract readComparative StudyMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Annals of the American Thoracic Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

11 authors.

Chad H HochbergDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Li YanDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
M Elizabeth CardDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Stephen A BerryDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Daniel BrodieDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Leo RotelloSection of Critical Care Medicine, Department of Medicine, Johns Hopkins Suburban Hospital, Bethesda, MD, United States.
Amirali NaderSection of Critical Care Medicine, Department of Medicine, Johns Hopkins Suburban Hospital, Bethesda, MD, United States.
Souvik ChatterjeeDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Sarina K SahetyaDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Theodore J IwashynaDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
David N HagerDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.

Funding

Sustainable Implementation of Prone Positioning for the Acute Respiratory Distress SyndromeK23HL169743 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Chad Hochberg · 2023 to 2026
$716k
NHBLI K23HL169743NHLBI NIH HHS K23 HL169743NIH
6 · The paper itself

Abstract

backgroundHypertensive emergency is characterized by end-organ dysfunction due to markedly elevated blood pressure. Although guidelines recommend rapid blood pressure lowering with intravenous antihypertensives and continuous monitoring in an intensive care unit (ICU), many patients are managed in intermediate care (IMC) settings. In this study, we compare outcomes of hypertensive emergency patients admitted to ICU vs IMC settings.

methodsAdult patients in the emergency departments of 3 hospitals were included if they had 2 or more systolic blood pressure measurements greater than 180 mm Hg within 12 hours of one another, were treated with continuous intravenous antihypertensive medications, and were subsequently admitted to an ICU or IMC setting. We excluded patients receiving mechanical ventilation in the emergency department and those presenting with acute coronary syndrome, aortic dissection, or acute cerebrovascular accident. The primary outcome was hospital length of stay (LOS) penalized for death and adjusted for baseline patient features. Secondary outcomes included ICU and IMC LOS and hospital mortality. Process outcomes included arterial line usage, frequency of blood pressure measurements in the first 24 hours, and escalations of care. Lastly, we report the proportion of patients reaching blood pressure targets and/or episodes of hypotension in each setting.

resultsIntensive care unit patients (n = 649) were younger, with a male predominance, more frequently received noninvasive respiratory support and were dialysis dependent than IMC patients (n = 629). In an adjusted analysis, there was no difference in time to hospital discharge between patients admitted to ICU vs IMC settings (absolute difference: +0.29 days; 95% CI, -0.07 to 0.70). Similarly, there was no difference in ICU vs IMC LOS, hospital readmission rate, or hospital mortality. Blood pressures were more frequently measured in the ICU, but there was no difference in time to target blood pressure goal. Any hypotensive episode in the first 24 hours was more common in the ICU.

conclusionsIn this retrospective observational study of patients with hypertensive emergency, we did not observe significantly different LOS outcomes between patients admitted to ICU vs IMC settings or detect a signal of harm among those admitted to IMC. Intermediate care settings may be a reasonable alternative to ICU admission for select patients with hypertensive emergency.

Indexed as

Antihypertensive AgentsCritical CareEmergency Service, HospitalHypertensionIntensive Care UnitsIntermediate Care FacilitiesAgedBlood PressureBlood Pressure DeterminationFemaleHospital MortalityHumansHypertensive CrisisLength of StayMaleMiddle AgedAntihypertensive Agentscare coordinationhypertensive emergencyintensive careintermediate caretriage

Identifiers

PMID41915559
PMCPMC13052349

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.