Sex-specific differences in clinical characteristics and organ damage in Hypertensive Urgencies

Acute blood pressure disorders are a common yet heterogeneous clinical challenge in the Emergency Department (ED), often requiring rapid assessment and risk stratification. Among these, Hypertensive Urgency (HU) is a frequent presentation, characterized by severely elevated blood pressure (BP) without acute hypertension-mediated organ damage (HMOD). Despite its clinical relevance, sex-related differences in HU remain poorly understood. This study aimed to investigate sex differences in clinical presentation, BP control and HMOD prevalence in subjects presenting with HU. Methods. A multicentric prospective study was conducted, enrolling symptomatic patients with HU, admitted to six Italian EDs. They were assessed within 72 h after ED discharge to evaluate BP control and to detect subclinical HMOD. A total of 257 patients were enrolled, including 134 females (52%). The mean age was 59.7 ± 14 years, with women being significantly older than men (62.4 ± 15 vs. 56.8 ± 13, p value = 0.002). Men were more frequently active smokers and had a higher rate of diabetes and obesity. They also had higher diastolic BP, at both ED admission and discharge, and higher systo-diastolic BP at the 72-h visit. Male sex was independently associated with increased rate of HMOD—regardless of the specific organ involved—and with poor BP control at 72 h from ED discharge. Compared to women, men with HU exhibited higher BP levels and poorer BP control at 72 h. They also showed a higher prevalence and greater severity of HMOD. Male sex emerged as independently associated with HMOD.