We read with great interest the report “Effect of Joint National Committee VII Report on Hospitalizations for Hypertensive Emergencies in the United States” by Deshmukh et al. The investigators provided a comprehensive overview of trends in hospitalizations and inpatient mortality for hypertensive emergencies before and after the publication of the Seventh Joint National Committee report on the prevention, detection, evaluation, and treatment of high blood pressure. They reported an average increase in hospitalizations of 1.11% and a decrease in inpatient mortality from 2.8% to 2.6% (after the publication of the report).

We had the opportunity to conduct a retrospective analysis on 567 patients admitted with hypertensive emergencies to 2 tertiary care centers that primarily serve an inner-city population. We found the long-term mortality after hospitalization with hypertensive emergencies to be as high as 12% per year after 3.1 years of follow-up, with age, coronary artery disease, and serum blood urea nitrogen levels being significant predictors. Thus, although inpatient mortality has been decreasing since the publication of the Seventh Joint National Committee report, hypertensive emergencies are associated with high long-term mortality.

Interestingly, patients with hypertensive emergencies frequently have cardiac troponin I (cTnI) levels drawn (96% in our study). In another study, cTnI was checked in about 1/3 of the patients who presented with hypertensive urgency. In our study, 32% patients had elevated cTnI levels, but neither the presence nor the magnitude of cTnI elevation predicted long-term mortality, reflecting its lack of utility for risk stratification. However, patients who had respiratory failure or pulmonary edema or needed mechanical ventilation had the highest cTnI elevations. Further analysis of cTnI by Deshmukh et al in their large database might help further clarify the utility of cTnI in these patients with hypertensive emergencies.

We acknowledge that our study was limited because of the lack of socioeconomic, insurance, and medication adherence data. We studied mainly African American patients admitted to 2 tertiary care centers in Detroit, raising the question of generalizability. We did not analyze the rate and predictors of hospitalizations for hypertensive emergencies. This topic will continue to fascinate researchers, because hypertension constitutes 1 of the foremost risk factors for cardiovascular diseases.