Association Between Age and Short-Term Outcomes Following Emergency Department Discharge For Severly Elevated Blood Pressure

Document Type

Conference Proceeding

Publication Date

10-2026

Publication Title

Annals of Emergency Medicine

Abstract

Although many patients presenting to the emergency department (ED) with severely elevated blood pressure are discharged home, limited data exist regarding whether increasing age is associated with worse short-term outcomes following ED discharge across varying degrees of hypertension (HTN) severity. Our primary Objective: was to evaluate the association between patient age and all-cause mortality within 30 days following ED discharge among patients presenting with severe HTN and stage 2 HTN. Secondary Objectives: included assessing the association between patient age and return visits to the ED within 30 days of discharge, as well as the association between patient age and adverse events within 30 days following ED discharge. Additionally, we sought to compare short-term outcomes between patients presenting with severe HTN and those with stage 2 hypertension across age groups. We conducted a retrospective observational cohort Study using electronic health record data from a large multi-center health system in southeast Michigan. Adult patients (≥18 years) discharged from the ED with a diagnosis of hypertension between January 2016 and February 2020 were included. Patients with prior antihypertensive treatment within 18 months, hospital admission, pregnancy, or missing demographic data were excluded. The primary outcome included 30-day all-cause mortality. The secondary outcome was a composite of 30-day adverse events (including acute heart failure, myocardial infarction, stroke, aortic catastrophe, and hypertensive encephalopathy) and ED revisit. Age was analyzed categorically (18–49, 50–64, 65–79, and ≥80 years). Stage 2 HTN was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg, while severe HTN was defined as SBP ≥180 mmHg and/or DBP ≥120 mmHg. Multivariable logistic regression was used to evaluate associations between age and outcomes while adjusting for gender, race, antihypertensive prescription at discharge, and Elixhauser Comorbidity Index. Adjusted odds ratios (aORs) with 95% confidence intervals were reported. Statistical significance was defined as p< 0.05.A total of 93,512 patients were included during the Study period. After adjustment for gender, race, antihypertensive prescription, and comorbidity burden, patients aged ≥80 years with stage 2 HTN had significantly increased odds of 30-day adverse events (aOR 5.3, 95% CI 4.04–7.41, p< 0.001) and all-cause mortality (aOR 17.7, 95% CI 7.49–52.33, p< 0.001) compared with patients aged 18–49 years, without significantly increased odds of 30-day ED revisits. Similarly, among patients presenting with severe HTN, patients aged ≥80 years had significantly increased odds of 30-day adverse events (aOR 4.4, 95% CI 2.42–8.57, p< 0.001) and all-cause mortality (aOR 15.4, p=0.013), while no significant association was observed between advanced age and 30-day ED revisits. Patients aged ≥80 years discharged from the ED with stage 2 HTN or severe HTN had significantly increased odds of 30-day adverse events and mortality despite no significant increase in ED revisits. These findings suggest that ED revisit rates may underestimate short-term risk in elderly patients with severely elevated blood pressure. Advanced age may represent an important marker of vulnerability following ED discharge and supports increased caution, closer outpatient follow-up, and more individualized discharge planning in this population.

Volume

88

Issue

4 Suppl 1

First Page

S185

Comments

American College of Emergency Physicians (ACEP) Research Forum, October 5-7, 2026, Chicago, IL

Last Page

S185

DOI

10.1016/j.annemergmed.2026.08.411

Link to Full Text

Share

COinS