Inpatient Admissions for Hypertensive Crises in the USA by Race and Gender: A Retrospective Study From the National Inpatient Sample From 2016 to 2022

Hypertension is a major cause of morbidity and mortality. Outpatient blood pressure control has declined over the past decade, particularly among Black patients. We examined whether this decline was associated with increased hospitalizations for hypertensive crises and assessed differences by race and gender. We analyzed the National Inpatient Sample (2016-2022) for admissions with hypertensive urgency or emergency. Outcomes included trends in admissions, mortality, length of stay (LOS), and cost of care (COC), with subgroup analyses by race and gender. Among 1 872 760 patients, 34.6% were Black and 50.8% were female. Black patients were younger (57.2 vs. 65.1 years) and almost similar comorbidity scores. Admissions increased from 41 455 (0.1%) in 2016 to 362 475 (1.1%) in 2022, with greater rises in Black (0.3%-2.5%) versus non-Black (0.1%-0.9%) patients, and in males (0.1%-1.1%) versus females (0.1%-0.9%). Mortality rose from 3.6% to 4.1%, remaining higher in non-Black (4.2%-4.8%) than Black (2.6%-2.9%) patients, and slightly higher in males. Median LOS was consistently 4 days without significant differences. Median COC was lower for Black ($44 425) and female ($47 530) patients. Multivariable analysis showed Black race and female gender were independently associated with lower mortality. Females also had a higher LOS and lower COC. Inpatient hypertensive crises increased substantially from 2016 to 2022, especially among Black and male patients. Despite higher admission rates, Black patients and females experienced lower mortality. These findings highlight the need for targeted interventions to improve outpatient hypertension management and reduce disparities.