Abstract TAC249: When Minutes Matter the Most: Temporal Trends for Hypertensive Urgency

Introduction: Hypertensive urgency requires prompt intervention to avoid progression to hypertensive emergency and its associated end organ damage. Clinicians should be aware of temporal patterns in presentation to improve patient care. The “weekend effect” describes disparities in clinical outcomes for patients admitted on the weekend compared to the weekday. This study aimed to investigate this effect in hypertensive urgency. Methods: Patients admitted with the primary diagnosis of hypertensive urgency were identified using the 2021 National Inpatient Sample (NIS). Logistic and linear regression models were used for analysis, adjusting for confounding variables using the Charlson comorbidity index. A univariate screen with a p-value cutoff of less than 0.2 was performed followed by a multivariate analysis. The threshold for statistical significance was set at a 2-tailed p-value of 0.05. Results: In 2021, the NIS reported 72095 patients that were admitted with a primary diagnosis of hypertensive urgency. Of these, 54179 were admitted on a weekday and 17916 were admitted on a weekend. The mortality rate of weekend admissions was not significantly different than weekday admissions (aOR 0.96, 95% CI 0.41-2.22). Baseline demographic characteristics were similar with regards to gender, age, and race. Length of hospital stay (aOR -0.05, 95% CI -0.16 -0.05), total hospital charges (aOR 795, 95% CI -585 - 2176), and odds of mechanical ventilation (aOR 0.98, 95% CI 0.45-2.14) were not significantly different between the two groups. There were increased odds of renal replacement therapy in the African American (aOR 1.94, 95% CI 1.61-2.34), Hispanic (aOR 2.81, 95% CI 2.25 – 3.50), and Asian (aOR 2.22, 95% CI 1.46-3.66) populations compared to Caucasians on the weekend. Conclusions: This study found that there was not a significant difference in mortality, length of hospital stay, total hospital charges, or use of mechanical ventilation between weekend and weekday admissions for hypertensive urgency. These findings may be explained by consistent resource distribution, adequate staffing, and timely delivery of medications, regardless of the day of the week. We did highlight that minority populations had increased odds of requiring renal replacement therapy on the weekend compared to the weekdays in the study group. In the future, close monitoring of renal function and developing targeted strategies to address this discrepancy will be key to improve outcomes.