Sociodemographic and Clinical Factors Associated with Hypertensive Crises

Abstract

High blood pressure (HBP) is one of the main public health problems worldwide and the most important modifiable risk factor for cardiovascular disease. Within this spectrum, hypertensive crises represent the most serious manifestation of poor blood pressure control and are classified as hypertensive urgencies, without acute damage to target organs, and hypertensive emergencies, characterized by progressive organ damage that is life-threatening and requires immediate management. Despite therapeutic advances, these crises continue to be frequent in emergency departments and are associated with high morbidity and mortality, especially when not treated promptly. Evidence shows that hypertensive crises are multifactorial in nature, resulting from the interaction between clinical factors and social determinants of health. Notable sociodemographic factors include advanced age, female gender in postmenopausal stages, membership in historically marginalized ethnic groups, and low socioeconomic status, all of which are associated with poorer control of hypertension, higher prevalence of comorbidities, and barriers to accessing healthcare. From a clinical point of view, poor chronic blood pressure control, lack of therapeutic adherence, chronic kidney disease, obstructive sleep apnea, and abrupt discontinuation of antihypertensive drugs emerge as the main risk factors. An integrative approach allows us to understand that social inequalities act through clinical mediators, increasing vulnerability to hypertensive crises.