Impact of Early Blood Pressure Reduction on Prognosis in ICU Patients with Severe Acute Hypertension: A Retrospective Study of the Medical Information Mart for Intensive Care IV (MIMIC-IV) Database

Impact of Early Blood Pressure Reduction on Prognosis in ICU Patients with Severe Acute Hypertension: A Retrospective Study of the Medical Information Mart for Intensive Care IV (MIMIC-IV) Database | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of Early Blood Pressure Reduction on Prognosis in ICU Patients with Severe Acute Hypertension: A Retrospective Study of the Medical Information Mart for Intensive Care IV (MIMIC-IV) Database Li Zhang, Yunqing Li, Weiqi Yang, Yixin He, Mei Yang, Weiwei Zhu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9060236/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Severe acute elevations in blood pressure (BP) are common among intensive care unit (ICU) patients and are associated with adverse clinical outcomes. This study investigated the association between early BP dynamics following severe acute hypertension and 30-day mortality. In this retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we included 4 895 ICU patients with severe acute hypertension, defined as at least one systolic blood pressure (SBP) measurement ≥ 180 mmHg. Restricted cubic spline (RCS) models were used to characterize the associations between 30-day mortality and four BP parameters measured 1 hour after the index episode: achieved systolic and diastolic BP (SBP-1h and DBP-1h) and their corresponding percent reductions (SBP-PR and DBP-PR). Survival analyses were conducted across predefined BP strata. The greatest reduction in BP occurred within the first hour after the index hypertensive episode. RCS analyses demonstrated U-shaped associations between 30-day mortality and both SBP-1h and SBP-PR, with nadirs at 156.76 mmHg for SBP-1h and 14.87% for SBP-PR. In multivariable Cox regression models, an SBP-1h of 140–180 mmHg or an SBP-PR of 5%-25% was associated with a significant survival benefit. Conversely, a DBP-1h 27% was associated with an increased risk of mortality. Among ICU patients with severe acute hypertension, maintaining BP within an optimal range during the early treatment period is associated with improved prognosis. Excessive reductions in either SBP or DBP are associated with increased 30-day mortality, highlighting the importance of avoiding overaggressive BP lowering in this population. Health sciences/Diseases/Cardiovascular diseases/Hypertension Health sciences/Health care/Prognosis Health sciences/Medical research/Clinical trial design Severe acute hypertension blood pressure control 30-day mortality target organ damage intensive care unit Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Marked and abrupt elevations in blood pressure (BP) are common and often unpredictable in hospitalized patients 1 , and are associated with adverse clinical outcomes, particularly increased short-term mortality 2 , 3 . This concern is especially relevant in the intensive care unit (ICU), where patients are hemodynamically unstable and frequently experience rapid BP fluctuations. Although substantial evidence and well-established guidelines support long-term BP targets for chronic hypertension 4 – 6 , considerably less attention has been directed toward optimal short-term BP control in the acute setting. In acute care, timely BP reduction is essential to prevent target organ damage (TOD), minimize the risk of hypertensive rebound, and allow safe clinical monitoring and therapeutic adjustment. For critically ill ICU patients, BP variability over short intervals is common, and determining an appropriate target range may be more clinically consequential than the selection of a specific antihypertensive agent 5 , 7 . Moreover, the complexity of critical illness and the high burden of comorbidities necessitate individualized BP management strategies tailored to diverse clinical scenarios 8 . Previous studies have primarily examined BP elevations in postoperative states, intracranial hemorrhage, or acute ischemic stroke 9 – 11 . However, a universally applicable BP target for asymptomatic but markedly elevated BP in the ICU has not been established. Most available evidence supports gradual BP reduction under close monitoring 12 , 13 . Current guidelines provide time-dependent BP targets, ranging from 1-hour to 24-48-hour intervals, for hypertensive emergencies (HE), along with distinct recommendations for BP management in acute ischemic stroke. Nevertheless, these recommendations are not readily generalizable to critically ill ICU patients without overt acute TOD 4 . Importantly, guideline recommendations employ heterogeneous approaches, incorporating both percentage-based BP reductions and absolute BP thresholds, with a primary emphasis on systolic BP (SBP)In contrast, clinical studies often stratify patients according to achieved post-treatment BP values. This inconsistency highlights the need to clarify optimal BP targets in the early treatment phase. Specifically, it remains essential to define both the appropriate absolute BP levels and the magnitude of BP reduction within the critical first hour following severe acute hypertension. METHODS Data source and study population Data were obtained from version 3.1 of the Medical Information Mart for Intensive Care IV (MIMIC-IV; https://mimic.mit.edu/), a large, publicly available, de-identified critical care database containing records from 94 458 ICU admissions between 2 008 and 2 022. Use of the database has been reviewed and approved by the Institutional Review Board of Beth Israel Deaconess Medical Center 14 . One author (certification ID: 665 79692) was granted credentialed access and performed the data extraction. We excluded ICU readmissions ( n = 29 117), patients aged 100 years ( n = 0), and ICU length of stay (LOS) < 24 hours ( n = 13 362). Among the remaining 51 979 unique ICU admissions, all recorded BP measurements during the ICU stay were screened. A total of 6 713 patients experienced at least one episode of severe acute hypertension, defined as an index systolic blood pressure (SBP-index) ≥180 mmHg with at least one subsequent BP measurement documented within 1 hour. To reduce clinical heterogeneity, we further excluded patients with compelling indications for condition-specific BP management according to current guidelines, including hypertensive emergencies, pregnancy, intracranial hemorrhage, acute ischemic stroke, aortic dissection, and pheochromocytoma crisis. After applying these criteria, 4 895 patients comprised the final study cohort. The detailed selection process is shown in Figure 1. The study was conducted in accordance with the Declaration of Helsinki. Given the fully de-identified nature of the MIMIC-IV database, the requirement for informed consent was waived. Data extraction and definitions Baseline data were extracted using PostgreSQL (version 17.1.12). Retrieved variables included demographic characteristics, laboratory results, ICU severity scores, medication exposure, comorbidities, surgical history, and survival outcomes. For variables with <10% missing data, multiple imputation by chained equations was used to address missingness. All longitudinal BP measurements and their corresponding timestamps throughout the ICU stay were extracted to characterize BP trajectories. Compelling indications requiring specialized BP management, as well as baseline comorbidities, were identified using International Classification of Diseases, Ninth and Tenth Revision codes (Table S1). BP data processing BP measurements and timestamps were processed using Python (version 3.10.11). Each occurrence of SBP ≥180 mmHg was identified as an episode of severe acute hypertension. The index BP was defined as the earliest recorded BP at the onset of a qualifying episode (SBP-index and DBP-index). The achieved BP was defined as the last BP measurement recorded within the subsequent 1-hour window (SBP-1h and DBP-1h). If no follow-up BP measurement was available within 1 hour of the initial episode, subsequent qualifying episodes were sequentially evaluated until an eligible episode with adequate follow-up data was identified. The percentage reduction in BP was calculated as follows: SBP-PR = [(SBP-index - SBP-1h) / SBP-index] × 100% DBP-PR = [[(DBP-index - DBP-1h) / DBP-index] × 100% Study endpoints The primary endpoint was 30-day all-cause mortality. Follow-up began at the time of the index episode of severe acute hypertension. Secondary endpoints included in-hospital acute clinical events indicative of TOD: Neurological dysfunction is defined as coma, indicated by a Glasgow Coma Scale score <915 .Renal dysfunction is defined as Stage 3 acute kidney injury (AKI) according to the Kidney Disease: Improving Global Outcomes criteria16. Statistical analysis All statistical analyses were conducted using R (version 4.5.0). Baseline characteristics were compared between 30-day survivors and non-survivors. Categorical variables are presented as counts and percentages and were compared using the chi-square test or Fisher’s exact test, as appropriate. Continuous variables are expressed as medians with interquartile ranges and were compared using the Student’s t test or Wilcoxon rank-sum test, depending on data distribution. Restricted cubic spline (RCS) models were used to assess and visualize potential non-linear associations between BP control parameters and 30-day all-cause mortality, with BP variables modeled as continuous measures. For SBP parameters, survival differences across clinically relevant strata were evaluated using Kaplan-Meier curves and compared with the log-rank test. Cox proportional hazards models were applied to estimate hazard ratios (HRs). For diastolic blood pressure (DBP) parameters, ROC curve analysis was performed to identify optimal thresholds for risk stratification, followed by survival analyses based on these cutoffs. Multivariable logistic regression models were used to examine the associations between BP control levels and secondary endpoints, including Stage 3 AKI and coma. Because the date of death in the database is recorded in days, whereas the onset of severe acute hypertension is timestamped in hours, a small number of patients who died on the same calendar day as the index episode had calculated survival times of zero or slightly negative values. To meet the non-negative time requirement for survival analysis, these survival times were reassigned to 0.1 days in accordance with standard statistical practice. Cox regression results are reported as hazard ratios (HRs), and logistic regression results as odds ratios (ORs), both with 95% confidence intervals (CIs). A two-sided P value < 0.05 was considered statistically significant. Multivariable models were specified as follows: Model 0: Unadjusted. Model 1: Adjusted for sex, age, and ethnicity. Model 2: Adjusted for Model 1 covariates plus comorbidities (myocardial infarction, heart failure, diabetes, renal disease, cerebrovascular disease, malignant tumor, peripheral vascular disease, chronic obstructive pulmonary disease (COPD), severe liver disease, rheumatic disease, pre-existing hypertension, and prior hypertension-related TOD), as well as sepsis, delirium, SBP-index, use of vasoactive agents, intravenous antihypertensive therapy, and timing of severe acute hypertension onset. Unless otherwise specified, all reported results are based on Model 2. RESULTS Baseline characteristics and BP dynamics During the 30-day follow-up period, 749 deaths occurred in the study cohort (364 females and 385 males). Compared with survivors, non-survivors were significantly older (73.39 vs. 67.15 years, P < 0.001) and had a higher burden of comorbidities, including myocardial infarction (18.83% vs. 13.84%, P < 0.001), congestive heart failure (28.97% vs. 23.32%, P = 0.001), cerebrovascular disease (21.09% vs. 14.47%, P < 0.001), COPD (28.70% vs. 25.08%, P = 0.04), liver disease (6.68% vs. 4.20%, P = 0.004), and malignant cancer (18.83% vs. 12.47%, P < 0.001). During the ICU stay, non-survivors were more likely to develop Stage 3 AKI (46.06% vs. 23.56%, P < 0.001), sepsis (80.37% vs. 56.87%, P < 0.001), coma (17.49% vs. 7.86%, P < 0.001), and delirium (43.66% vs. 37.39%, P = 0.001). Accordingly, they required more intensive organ support, including continuous renal replacement therapy (15.35% vs. 6.08%, P < 0.001), mechanical ventilation (87.32% vs. 82.63%, P = 0.001), and vasoactive agents (54.07% vs. 31.21%, P < 0.001). Notably, intravenous antihypertensive therapy was administered less frequently in non-survivors (52.60% vs. 67.75%, P < 0.001), and pre-existing hypertension was less prevalent in this group (72.36% vs. 79.88%, P < 0.001). Regarding BP profiles, baseline SBP (131 vs. 141 mmHg, P < 0.001) and baseline DBP (69 vs. 72 mmHg, P < 0.001) were significantly lower among non-survivors. Similarly, mean SBP (129.22 vs. 136.90 mmHg, P < 0.001) and mean DBP (62.29 vs. 67.84 mmHg, P < 0.001) during the ICU stay were lower in the mortality group. In contrast, maximum SBP was slightly higher in non-survivors (196 vs. 192 mmHg, P < 0.001). The onset of severe acute hypertension occurred significantly later in non-survivors compared with survivors (80.93 hours vs. 40.27 hours from ICU admission, P < 0.001). At the index episode, SBP was marginally higher (187 vs. 186 mmHg, P = 0.004), whereas DBP was slightly lower (86 vs. 87 mmHg, P = 0.002) in patients who died. One hour after the episode, achieved BP levels were consistently lower in non-survivors (SBP-1h: 147 vs. 155 mmHg; DBP-1h: 67 vs. 73 mmHg; both P < 0.001) (Table 1; Table S2). The most pronounced BP reduction occurred within the first hour following the onset of severe acute hypertension. Median SBP decreased from 186 mmHg to 154 mmHg, and median DBP decreased from 87 mmHg to 72 mmHg (Figure 2A-B). Association between BP Control and 30-day mortality RCS analyses were performed to characterize the associations between BP control parameters and 30-day mortality. A significant U-shaped relationship was observed between mortality and both SBP-1h (Figure 3A) and SBP-PR (Figure 3C). The nadirs of the spline curves corresponded to an SBP-1h of approximately 156.76 mmHg and an SBP-PR of 14.87%, suggesting these values as potential optimal targets (Table 2). In contrast, no clear U-shaped association was identified between mortality and either DBP-1h (Figure 3B) or DBP-PR (Figure 3D). Nevertheless, a consistent trend indicated that excessive reductions in DBP were associated with increased mortality risk, particularly at lower achieved DBP levels and higher reduction percentages. Impact of SBP-1h and SBP-PR on mortality To further evaluate prognostic implications, patients were stratified according to SBP-1h and SBP-PR categories (Tables 3 and 4). Using SBP-1h ≥180 mmHg as the reference group, patients whose SBP-1h was maintained between 140 and 180 mmHg demonstrated a significant survival advantage (Table S8). The most pronounced benefit was observed in patients with SBP-1h between 150 and 160 mmHg (HR 0.62, 95% CI 0.46-0.82, P < 0.001) and between 160 and 170 mmHg (HR 0.62, 95% CI 0.47-0.83, P = 0.001). Similarly, when stratified by reduction magnitude, patients with no SBP reduction (SBP-PR ≤0%) served as the reference group. An SBP-PR between 5% and 25% was associated with a significantly lower risk of 30-day mortality (Table S9). Notably, an SBP-PR of 15-20% conferred the greatest survival benefit (HR 0.56, 95% CI 0.39-0.80, P = 0.002). Kaplan-Meier curves further illustrated improved survival among patients whose SBP was controlled within these optimal ranges (Figure 4A-B). Impact of DBP-1h and DBP-PR on mortality Patients were also stratified according to DBP-1h and DBP-PR. Compared with patients whose DBP-1h was ≥110 mmHg, those maintained within the 70-80 mmHg range experienced a significant survival benefit (HR 0.64, 95% CI 0.44-0.95, P = 0.03) (Tables S6-S7). However, no specific DBP-PR category demonstrated a statistically significant survival advantage in categorical analyses. To further refine risk stratification, ROC curve analyses were performed (Figure S1; Table S3). The optimal prognostic thresholds were identified as 70 mmHg for DBP-1h and 27% for DBP-PR. Subsequent Kaplan-Meier analyses (Figure 4C-D) showed that patients with DBP-1h 27% had significantly higher mortality rates (P < 0.001). These associations were confirmed in multivariable Cox proportional hazards models (Tables S10-S11). Association between BP targets and secondary endpoints The effects of SBP control categories on secondary endpoints, coma and Stage 3 AKI, were further examined. RCS analyses demonstrated U-shaped relationships between both SBP-1h and SBP-PR and the incidence of these complications (Figures S2-S3; Table S4). Multivariable logistic regression models were used to quantify the risks associated with excessive or insufficient BP reduction. Using SBP-1h 140-180 mmHg as the reference category, patients with SBP-1h <140 mmHg had a significantly increased risk of Stage 3 AKI (OR 1.19, 95% CI 1.02-1.40, P = 0.03) and a borderline higher risk of coma (OR 1.25, 95% CI 1.00-1.56, P = 0.05). Similarly, compared with an SBP-PR of 5%-25%, an SBP-PR >25% was associated with a higher risk of Stage 3 AKI (OR 1.23, 95% CI 1.04-1.45, P = 0.01) (Tables S12-S15). For diastolic parameters, a DBP-1h <70 mmHg was associated with a significantly greater incidence of Stage 3 AKI compared with DBP-1h ≥70 mmHg (OR 1.18, 95% CI 1.02-1.36, P = 0.03). However, no significant association was observed between DBP categories and the occurrence of coma (Tables S16-S19). . Associations between covariates and clinical outcomes Associations between additional covariates and clinical outcomes are presented in Table S5. The multivariate analysis identified sepsis as a major independent predictor of 30-day mortality (HR 2.03, 95% CI 1.71-2.42, P 24h was associated with an increased risk of death (HR 1.44, 95% CI 1.23-1.68, P < 0.001). Conversely, the administration of intravenous antihypertensive therapy appeared to confer a survival benefit, significantly lowering the risk of mortality (HR 0.72, 95% CI 0.61-0.85, P < 0.001). DISCUSSION In this large real-world cohort of 4 895 critically ill patients from the MIMIC-IV database, we found that achieving BP within an optimal range during the first hour after a severe acute hypertensive episode was associated with a significant reduction in 30-day mortality. In contrast, excessive BP lowering was associated not only with increased mortality but also with a higher incidence of acute complications, including coma and Stage 3 AKI. These associations remained robust after adjustment for key confounders, including demographic characteristics and comorbid conditions. Importantly, our findings consistently highlight the relevance of both systolic and diastolic parameters. Similar conclusions were obtained whether BP control was assessed using absolute achieved values (e.g., SBP-1h) or percentage reductions (e.g., SBP-PR). The spline analyses identified optimal targets of approximately 156.76 mmHg for SBP-1h and 14.87% for SBP-PR, with clinically meaningful benefit observed within broader ranges of 140–180 mmHg and 5%-25%, respectively. Notably, the adverse associations of excessive SBP reduction with coma and Stage 3 AKI were more pronounced than those observed with insufficient SBP reduction, suggesting the potential harm of overaggressive BP lowering in critically ill patients. With respect to diastolic BP, a DBP-1h 27% was associated with increased 30-day mortality. These findings further emphasize the need to avoid excessive diastolic hypotension during early BP management, as diastolic perfusion pressure may be particularly critical for maintaining coronary and end-organ blood flow in vulnerable ICU populations. The 2 025 guidelines from the American Heart Association recommend that in patients with HE, SBP should be reduced by no more than 25% within the first hour, followed by a target of approximately 160/100 mmHg over the subsequent 2–6 hours 4 . Similarly, the 2 024 guidelines from the European Society of Cardiology advise lowering SBP to < 180 mmHg within the first hour 6 . Although the clinical scenarios addressed in these guidelines differ from the population examined in our study, the numerical targets identified in our analysis are notably consistent with these recommendations. According to the 2 024 American Heart Association Scientific Statement, the patients included in our cohort would be classified as having hypertensive urgency (HU), or asymptomatic markedly elevated inpatient BP 17 . Current guidelines provide limited direction regarding specific BP reduction targets for this population, instead emphasizing the potential harm associated with overly aggressive BP lowering 4 . Despite HU being considerably more prevalent than HE 2 , it has received substantially less investigative attention 17 , 18 . Our findings help address this gap by providing empirical data to inform BP management in this clinically ambiguous “gray zone.” Moreover, guideline recommendations primarily focus on SBP, with relatively little emphasis on DBP. Some studies circumvent SBP-DBP discrepancies by using mean arterial pressure as a composite measure 19 , 20 . In contrast, our study separately evaluated systolic and diastolic parameters and identified clinically relevant DBP thresholds. These results offer a foundation for future prospective studies and randomized controlled trials aimed at refining early BP targets in critically ill patients. The adverse consequences of abrupt BP elevation are largely mediated by the risk of acute TOD. Compared with HU, HE carries a higher immediate mortality risk because TOD is already present 21 , 22 . Nevertheless, both conditions share a common pathophysiological basis: a sudden increase in systemic vascular resistance. This elevation can induce microvascular injury, activate the renin-angiotensin-aldosterone system (RAAS), promote systemic vasoconstriction, and trigger pressure natriuresis with subsequent volume depletion, thereby establishing a feed-forward cycle that further aggravates hypertension. Although autoregulatory mechanisms in vital organs typically buffer transient BP fluctuations, failure of these mechanisms may result in serious complications such as cerebral edema, intracranial hemorrhage, acute heart failure, and AKI 2 , 18 , 23 – 25 . Importantly, overly rapid pharmacologically induced BP reduction may be equally harmful 5 , 26 . Prior studies have suggested that intravenous antihypertensive therapy in patients with severe acute hypertension may increase the risk of AKI 3 . In our cohort, the observed associations between excessive BP reduction and higher incidences of coma and Stage 3 AKI support this concern. These findings provide a plausible mechanistic explanation for the increased mortality observed in patients with overaggressive BP control. A key limitation of this study, however, is the inability to definitively determine the temporal sequence between BP elevation episodes and the onset of subsequent clinical events, which precludes firm conclusions regarding causality. Management strategies for HE, as well as for specific high-risk conditions, including pregnancy-related hypertension, intracranial hemorrhage, acute ischemic stroke, aortic dissection, and pheochromocytoma crisis, have been extensively investigated and are supported by established clinical consensus 8 , 28 . These populations differ substantially from the cohort examined in our study and may independently influence secondary outcomes such as AKI or neurological dysfunction. To minimize confounding, these patients were excluded from the present analysis. Just as HE encompasses heterogeneous patterns of organ injury and clinical trajectories 2 , 21 , HU likely represents a similarly heterogeneous entity. Future studies should therefore aim to refine BP targets according to precipitating factors, underlying etiologies, and specific patterns of TOD. The critically ill population included in this study possesses distinctive clinical features. Unlike patients in the general ward or community setting, who often present to the emergency department with overt TOD, facilitating the diagnosis of HE and prompting symptom-driven intravenous antihypertensive therapy, the ICU environment allows for continuous and high-resolution hemodynamic monitoring. This enables earlier identification of severe acute hypertension, frequently before overt organ injury develops. However, management in the ICU is complicated by severe comorbid conditions, fluctuating hemodynamics, and often lower baseline MAP 20 , making early recognition of progression to HE more challenging when relying solely on integrated clinical signs 29 . Importantly, our findings suggest that the timing of severe acute hypertension onset has prognostic significance. Mortality was substantially higher among patients whose hypertensive episodes occurred more than 24 hours after ICU admission. This temporal pattern resembles that observed with certain postoperative complications, in which delayed onset is often associated with worse outcomes 30 . A comparable analogy can be drawn to the distinction between community-acquired and hospital-acquired pneumonia 31 , where timing reflects differences in underlying pathophysiology and risk profile. In severe acute hypertension, delayed onset may indicate a greater contribution from iatrogenic or in-hospital factors. Given that severe acute hypertension is influenced by diverse precipitating factors and prognostic determinants 23 , optimal control strategies should be tailored accordingly. These areas represent critical directions for future investigation. This study provides an overall characterization of intravenous antihypertensive use during episodes of severe acute hypertension. Importantly, our primary objective was to evaluate therapeutic BP targets rather than the specific pharmacologic agents used to achieve them. Although intravenous antihypertensive administration was documented, the precise temporal relationship between drug delivery and the onset of BP elevation could not be definitively established. In addition, we did not perform a direct comparison between oral and intravenous antihypertensive agents. This was partly due to inherent limitations of the database and, more importantly, because such comparisons were beyond the scope of the present investigation. Numerous clinical studies, including several well-designed randomized controlled trials, have examined pharmacologic strategies for BP management 7 , 9 – 11 , 19 , 32 , particularly in conditions secondary to acute hypertension, such as intracranial hemorrhage 28 . However, substantial inter-patient heterogeneity complicates efforts to simultaneously standardize medication dosing and predefined BP targets. As a result, establishing a direct causal relationship between specific antihypertensive agents and clinical outcomes remains challenging 18 . In routine clinical practice, pharmacologic therapy must be individualized according to each patient’s overall condition, comorbidity profile, and hemodynamic status 4 , 13 , 19 . These complexities highlight important directions for future research. CONCLUSION In this cohort of 4 895 critically ill patients with severe acute hypertension from the MIMIC-IV database, maintaining SBP-1h within 140–180 mmHg or achieving an SBP-PR of 5%-25% was associated with significantly improved clinical outcomes compared with persistently uncontrolled SBP. In contrast, an SBP-1h 25%, DBP-1h 27% were independently associated with increased mortality and a higher incidence of adverse events, including coma and Stage 3 AKI. These findings suggest that moderate early BP reduction confers clinical benefit, whereas overly aggressive BP lowering may compromise end-organ perfusion and worsen prognosis in the ICU setting. Declarations ACKNOWLEDGEMENTS The authors are grateful to the participants in the Medical Information Mart for Intensive Care-IV database and to all those who participated in the study. AUTHOR CONTRIBUTIONS Yunqing Li, Weiwei Zhu took part in the study design, performed statistical analyses and drafted the manuscript. Yunqing Li, Yixin He and Weiqi Yang had the access permission to MIMIC-IV 3.0 and extracted data for the present study. Qishan Chen, Mei Yang, Weiguo Zhu and Li Zhang conceived of the study and revised the manuscript critically for important intellectual content. FUNDING The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. AVAILABILITY OF DATA AND MATERIALS No datasets were generated or analysed during the current study. Ethics approval and consent to participate The data in the MIMIC-IV public database have passed the ethical review of the original study, and no further ethical review and informed consent is required. CONSENT FOR PUBLICATION All authors have consented to the publication of the paper. COMPETING INTERESTS The authors declare no competing interests. References Desta DM, Wondafrash DZ, Tsadik AG, et al. 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Severe inpatient hypertension prevalence and blood pressure response to antihypertensive treatment. J Clin Hypertens (Greenwich). 2 022. Asfar P, Meziani F, Hamel JF, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2 014;370(17):1 583-93. Guiga H, Decroux C, Michelet P, et al. Hospital and out-of-hospital mortality in 670 hypertensive emergencies and urgencies. J Clin Hypertens (Greenwich). 2 017. Vallelonga F, Cesareo M, Menon L, et al. Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO. Hypertens Res. 2 023. Miller JB, Hrabec D, Krishnamoorthy V, et al. Evaluation and management of hypertensive emergency. BMJ. 2 024;386:e077 205. Szczech LA, Granger CB, Dasta JF, et al. Acute kidney injury and cardiovascular outcomes in acute severe hypertension. Circulation. 2 010;121(20):2 183-91. Coca SG, Garg AX, Swaminathan M, et al. Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. Nephrol Dial Transplant. 2 013. Johnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiol Clin. 2 012;30(4):533-43. Bihain F, Nomine-Criqui C, Guerci P, et al. Management of Patients with Treatment of Pheochromocytoma: A Critical Appraisal. Cancers (Basel). 2 022. Benenson I, Waldron FA, Holly C. A Systematic Review and Meta-analysis of the Clinical and Epidemiological Characteristics of Patients with Hypertensive Emergencies. High Blood Press Cardiovasc Prev. 2 023. Wakeam E, Hyder JA, Tsai TC, et al. Complication timing and association with mortality in the American College of Surgeons' National Surgical Quality Improvement Program database. J Surg Res. 2 015 Jan;193(1):77-87. doi: 10.1 016/j.jss.2 014.08.025. Epub 2 014 Aug 21. PMID: 252 60955. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2 017 Sep 10;50(3):170 0582. doi: 10.1 183/139 93003.00 582-2 017. PMID: 288 90434. Ghazi L, Li F, Chen X, et al. Blood pressure response to commonly administered antihypertensives for severe inpatient hypertension. PLoS One. 2 022. He J, Zhang Y, Xu T, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA. 2 014;311(5):479-89. Tables Table 1. Baseline characteristics and comorbidities by 30-day survival condition in critically ill patients with severe acute hypertension. Variable Overall ( n = 4895) Survivors ( n = 4146) Non-survivors ( n = 749) P Demographics Male, n (%) 2 704 (55.24) 2 319 (55.93) 385 (51.40) 0.02 Age (year) 68.08 (56.90 - 79.01) 67.15 (56.43 - 78.01) 73.39 (61.73 - 83.00) <0.001 White, n (%) 2 976 (60.80) 2 544 (61.36) 432 (57.68) 0.06 Medical History Myocardial infarction, n (%) 715 (14.61) 574 (13.84) 141 (18.83) <0.001 Congestive heart failure, n (%) 1 184 (24.19) 967 (23.32) 217 (28.97) 0.001 Peripheral vascular disease, n (%) 575 (11.75) 486 (11.72) 89 (11.88) 0.90 Cerebrovascular disease, n (%) 758 (15.49) 600 (14.47) 158 (21.09) <0.001 COPD, n (%) 1 255 (25.64) 1 040 (25.08) 215 (28.70) 0.04 Rheumatic disease, n (%) 189 (3.86) 153 (3.69) 36 (4.81) 0.15 Diabetes, n (%) 1 743 (35.61) 1 515 (36.54) 228 (30.44) 0.001 Renal disease, n (%) 1 209 (24.70) 1 025 (24.72) 184 (24.57) 0.96 Severe liver disease, n (%) 224 (4.58) 174 (4.20) 50 (6.68) 0.004 Malignant cancer, n (%) 658 (13.44) 517 (12.47) 141 (18.83) <0.001 Pre-existing hypertension, n (%) 3 854 (78.73) 3 312 (79.88) 542 (72.36) <0.001 Hypertensive TOD, n (%) 1 450 (29.62) 1 237 (29.84) 213 (28.44) 0.46 In-hospital Complications AKI, n (%) 3 939 (80.47) 3 263 (78.70) 676 (90.25) <0.001 Stage 3 AKI, n (%) 1 322 (27.01) 977 (23.56) 345 (46.06) <0.001 Sepsis, n (%) 2 960 (60.47) 2 358 (56.87) 602 (80.37) <0.001 Severe coma, n (%) 457 (9.34) 326 (7.86) 131 (17.49) <0.001 Delirium, n (%) 1 877 (38.35) 1 550 (37.39) 327 (43.66) 0.001 BP Parameters SBP-baseline (mmHg) 139 (118 - 160) 141 (119 - 161) 131 (110 - 154) <0.001 DBP-baseline (mmHg) 71 (59 - 86) 72 (60 - 87) 69 (57 - 82) <0.001 Timing of severe acute hypertension onset (hour) 50.66 (6.22 - 100.05) 40.27 (5.08 - 96.56) 80.93 (21 - 122.48) <0.001 SBP-index (mmHg) 186 (182 - 193) 186 (182 - 192) 187 (182 - 194) 0.004 DBP-index (mmHg) 87 (75 - 101) 87 (75 - 101) 86 (71 - 100) 0.002 SBP-1h (mmHg) 154 (133 - 172) 155 (135 - 172) 147 (121 - 170) <0.001 DBP-1h (mmHg) 72 (60 - 86) 73 (61 - 87) 67 (55 - 81) <0.001 In-hospital mean SBP (mmHg) 135.75 (124.48 - 146.15) 136.90 (125.72 - 146.93) 129.22 (117.21 - 140.91) <0.001 In-hospital mean DBP (mmHg) 67.01 (59.59 - 75.29) 67.84 (60.44 - 76.04) 62.29 (55.75 - 69.90) <0.001 In-hospital max SBP (mmHg) 193 (185 - 205) 192 (185 - 204) 196 (187 - 210) <0.001 In-hospital max DBP (mmHg) 117 (101 - 137) 117 (101 - 137) 114 (99 - 138) 0.10 Vital Signs Heart rate (bpm) 87 (73 - 102) 86 (73 - 102) 89 (74 - 104) 0.03 Temperature (℃) 36.78 (36.44 - 37.17) 36.78 (36.44 - 37.17) 36.67 (36.33 - 37.06) <0.001 Respiratory rate (bpm) 19 (16 - 23.75) 19 (15 - 23) 20 (17 - 25) <0.001 Treatments Ventilator use, n (%) 4 080 (83.35) 3 426 (82.63) 654 (87.32) 0.001 CRRT, n (%) 367 (7.50) 252 (6.08) 115 (15.35) <0.001 Antihypertensive medications, n (%) 4 569 (93.34) 3 895 (93.95) 674 (89.99) <0.001 Intravenous antihypertensive agents, n (%) 3 203 (65.43) 2 809 (67.75) 394 (52.60) <0.001 Vasoactive agents, n (%) 1 699 (34.71) 1 294 (31.21) 405 (54.07) <0.001 Hospital Stay (day) 10.02 (5.74 - 18.05) 10.33 (5.87 - 18.85) 8.86 (4.71 - 14.65) <0.001 Abbreviations: SBP, Systolic Blood Pressure; SBP-index, Index Systolic Blood Pressure; SBP-1h, Achieved Systolic Blood Pressure at 1 hour; SBP-PR, Systolic Blood Pressure Percentage Reduction; DBP, Diastolic Blood Pressure; DBP-index, Index Diastolic Blood Pressure; DBP-1h, Achieved Diastolic Blood Pressure at 1 hour; DBP-PR, Diastolic Blood Pressure Percentage Reduction; COPD, Chronic Obstructive Pulmonary Disease; TOD, Target Organ Damage; HHD, Hypertensive Heart Disease; HKD, Hypertensive Kidney Disease; AKI, Acute Kidney Injury; CRRT, Continuous Renal Replacement Therapy; RAASi, Renin–Angiotensin–Aldosterone System Inhibitors; CCB, Calcium Channel Blockers; SNP, Sodium Nitroprusside; SCr, Serum Creatinine; WBC, White Blood Cell Count; Hb, Hemoglobin; LOS, Length of Stay. Table 2. Identification of optimal blood pressure control targets within the first hour for 30-day mortality from Restricted Cubic Spline Analysis. BP Parameters Nadir Value SBP-1h 156.76 mmHg DBP-1h 71.63 mmHg SBP-PR 14.87% DBP-PR / Abbreviations: SBP-1h, Achieved Systolic Blood Pressure at 1 hour; SBP-PR, Systolic Blood Pressure Percentage Reduction; DBP, Diastolic Blood Pressure; DBP-1h, Achieved Diastolic Blood Pressure at 1 hour; DBP-PR, Diastolic Blood Pressure Percentage Reduction. Table 3. Multivariate Cox proportional hazards analysis of achieved systolic blood pressure (SBP-1h) and 30-day mortality. Model SBP-1h n n of events HR (95% CI) P Model 0 ≥ 180 mmHg 710 114 1 Ref. 170 mmHg - 180 mmHg 654 77 0.71 (0.54, 0.95) 0.02 160 mmHg - 170 mmHg 738 86 0.71 (0.53, 0.93) 0.01 150 mmHg - 160 mmHg 644 80 0.75 (0.57, 1.00) 0.05 140 mmHg - 150 mmHg 577 74 0.79 (0.59, 1.05) 0.11 130 mmHg - 140 mmHg 511 84 1.03 (0.77, 1.36) 0.86 120 mmHg - 130 mmHg 327 56 1.08 (0.78, 1.49) 0.64 < 120 mmHg 734 178 1.61 (1.27, 2.04) <0.001 Model 1 ≥ 180 mmHg 710 114 1 Ref. 170 mmHg - 180 mmHg 654 77 0.71 (0.54, 0.95) 0.02 160 mmHg - 170 mmHg 738 86 0.70 (0.53, 0.92) 0.01 150 mmHg - 160 mmHg 644 80 0.76 (0.57, 1.01) 0.06 140 mmHg - 150 mmHg 577 74 0.79 (0.59, 1.06) 0.11 130 mmHg - 140 mmHg 511 84 1.04 (0.78, 1.38) 0.80 120 mmHg - 130 mmHg 327 56 1.09 (0.79, 1.50) 0.59 < 120 mmHg 734 178 1.65 (1.30, 2.08) <0.001 Model 2 ≥ 180 mmHg 710 114 1 Ref. 170 mmHg - 180 mmHg 654 77 0.68 (0.51, 0.91) 0.01 160 mmHg - 170 mmHg 738 86 0.62 (0.47, 0.83) 0.001 150 mmHg - 160 mmHg 644 80 0.62 (0.46, 0.82) <0.001 140 mmHg - 150 mmHg 577 74 0.66 (0.49, 0.88) 0.01 130 mmHg - 140 mmHg 511 84 0.77 (0.58, 1.03) 0.08 120 mmHg - 130 mmHg 327 56 0.78 (0.56, 1.08) 0.13 < 120 mmHg 734 178 1.05 (0.82, 1.35) 0.68 Relationship between diastolic blood pressure percentage reduction and 30-day mortality, with SBP-1h categorized into eight subgroups based on thresholds of 120mmHg, 130mmHg, 140mmHg, 150mmHg, 160mmHg, 170mmHg, and 180mmHg. The group with SBP-1h ≥ 180mmHg serves as the reference. In model 1, covariates included age, sex and race. In model 2, covariates included age, sex, race, comorbidities (myocardial infarction, heart failure, diabetes, renal disease, cerebrovascular disease, malignant tumor, peripheral vascular disease, chronic pulmonary disease (COPD), severe liver disease, rheumatic disease, pre-existing hypertension, and prior TOD due to hypertension), sepsis, delirium, SBP-index, the use of vasoactive agents, intravenous antihypertensive therapy, and the timing of severe acute hypertension onset. Abbreviations: BP, Blood Pressure; SBP, Systolic Blood Pressure; DBP, Diastolic Blood Pressure; SBP-index, Index Systolic Blood Pressure; SBP-1h, Achieved Systolic Blood Pressure at 1 hour; HR, Hazard Ratio; CI, Confidence Interval; COPD, Chronic Obstructive Pulmonary Disease; TOD, Target Organ Damage. Table 4. Multivariate Cox proportional hazards analysis of systolic blood pressure percentage reduction (SBP-RR) and 30-day mortality. Model SBP-PR n n of events HR (95% CI) P Model 0 ≤ 0% 372 55 1 Ref. 0% - 5% 481 75 1.05 (0.74, 1.49) 0.77 5% - 10% 676 75 0.73 (0.52, 1.03) 0.08 10% - 15% 601 81 0.89 (0.63, 1.26) 0.52 15% - 20% 604 66 0.72 (0.50, 1.03) 0.07 20% - 25% 476 57 0.80 (0.55, 1.15) 0.23 25% - 30% 436 72 1.13 (0.80, 1.60) 0.50 > 30% 1 249 268 1.52 (1.14, 2.03) 0.005 Model 1 ≤ 0% 372 55 1 Ref. 0% - 5% 481 75 1.08 (0.76, 1.53) 0.67 5% - 10% 676 75 0.72 (0.51, 1.02) 0.07 10% - 15% 601 81 0.90 (0.64, 1.27) 0.56 15% - 20% 604 66 0.73 (0.51, 1.04) 0.09 20% - 25% 476 57 0.80 (0.55, 1.16) 0.24 25% - 30% 436 72 1.16 (0.81, 1.64) 0.42 > 30% 1 249 268 1.56 (1.17, 2.09) 0.003 Model 2 ≤ 0% 372 55 1 Ref. 0% - 5% 481 75 0.95 (0.67, 1.34) 0.76 5% - 10% 676 75 0.60 (0.43, 0.86) 0.005 10% - 15% 601 81 0.79 (0.56, 1.12) 0.18 15% - 20% 604 66 0.56 (0.39, 0.80) 0.002 20% - 25% 476 57 0.63 (0.43, 0.91) 0.02 25% - 30% 436 72 0.82 (0.57, 1.17) 0.26 > 30% 1 249 268 0.96 (0.71, 1.31) 0.80 Relationship between SBP-PR and 30-day mortality, with SBP-PR categorized into eight subgroups based on thresholds of 0, 5%, 10%, 15%, 20%, 25%, and 30%. The group with SBP-PR ≤ 0% serves as the reference. In model 1, covariates included age, sex and race. In model 2, covariates included age, sex, race, comorbidities (myocardial infarction, heart failure, diabetes, renal disease, cerebrovascular disease, malignant tumor, peripheral vascular disease, chronic pulmonary disease (COPD), severe liver disease, rheumatic disease, pre-existing hypertension, and prior TOD due to hypertension), sepsis, delirium, SBP-index, the use of vasoactive agents, intravenous antihypertensive therapy, and the timing of severe acute hypertension onset. Abbreviations: BP, Blood Pressure; SBP, Systolic Blood Pressure; DBP, Diastolic Blood Pressure; SBP-index, Index Systolic Blood Pressure; RCS, Restricted Cubic Splines; DBP, Diastolic Blood Pressure; SBP-PR, Systolic Blood Pressure Percentage Reduction; AKI, Acute Kidney Injury; HR, Hazard Ratio; CI, Confidence Interval; COPD, Chronic Obstructive Pulmonary Disease; TOD, Target Organ Damage. Additional Declarations There is NO conflict of interest to disclose. Supplementary Files SupplementaryMaterial.pdf Supplemental Material Cite Share Download PDF Status: Under Review Version 1 posted Review # 1 received at journal 28 Apr, 2026 Reviewer # 1 agreed at journal 16 Apr, 2026 First submitted to journal 16 Mar, 2026 Unknown event 16 Mar, 2026 Reviewers invited by journal 11 Mar, 2026 Submission checks completed at journal 09 Mar, 2026 Editor assigned by journal 07 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9060236","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":604443967,"identity":"54b20d7f-5090-43a1-af1b-6ec76b65f35d","order_by":0,"name":"Li Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBACPmYGBmYQg5+BByp0gIAWNpgWyQaitTBAtRgcIFoLOwPz54KaO3abz589/OlmG4Mc340Exs8FBBxmPOPYs+RtN/LSpHPbGIwlbyQwS88goCWZh+1wstkNHjNmoJbEDTcS2Jh5CGg5zPPvcLJx/xnjz0At9cRoYWzmbTtsZ8CQYwByWIIBYS2Mzcy8fYcTJG7kmEnnnJMwnHnmYbM0Pi38/IcPf+b5dtieH+SwnDIbeb7jyQc/49PCwMDYACITGyA8CbgIQWBPlKpRMApGwSgYmQAAaDRDLl0saKYAAAAASUVORK5CYII=","orcid":"","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhang","suffix":""},{"id":604443969,"identity":"1cca55d1-229b-4bac-8280-52c81293479f","order_by":1,"name":"Yunqing Li","email":"","orcid":"https://orcid.org/0009-0006-9396-7035","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yunqing","middleName":"","lastName":"Li","suffix":""},{"id":604443974,"identity":"fcb6dd27-b3eb-4491-b309-8be49baaf0c4","order_by":2,"name":"Weiqi Yang","email":"","orcid":"","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Weiqi","middleName":"","lastName":"Yang","suffix":""},{"id":604443977,"identity":"83361b4c-8194-44b0-91e5-b6e9e70919be","order_by":3,"name":"Yixin He","email":"","orcid":"","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yixin","middleName":"","lastName":"He","suffix":""},{"id":604443978,"identity":"1311a2f2-6a01-4769-8b7c-c2f9dff7ba4c","order_by":4,"name":"Mei Yang","email":"","orcid":"","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mei","middleName":"","lastName":"Yang","suffix":""},{"id":604443980,"identity":"2aab97bf-b9f2-4f30-bc6c-35a6ef72a561","order_by":5,"name":"Weiwei Zhu","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Zhu","suffix":""},{"id":604443982,"identity":"4bb8664d-3da4-4a88-809f-21d118116c15","order_by":6,"name":"Qishan Chen","email":"","orcid":"","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qishan","middleName":"","lastName":"Chen","suffix":""},{"id":604443983,"identity":"83873d33-25d3-42ce-913b-bab718d2338e","order_by":7,"name":"Weiguo Zhu","email":"","orcid":"","institution":"Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Weiguo","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2026-03-07 18:15:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9060236/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9060236/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104689986,"identity":"719ee3dc-625b-4672-aa94-fef0c34bf64f","added_by":"auto","created_at":"2026-03-16 06:03:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29201,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of patient inclusion and exclusion from the MIMIC-IV database.\u003c/p\u003e\n\u003cp\u003eAbbreviations: MIMIC-IV, Medical Information Mart for Intensive Care-IV; ICU, intensive care unit; SBP, systolic blood pressure.\u003c/p\u003e","description":"","filename":"Binder31.png","url":"https://assets-eu.researchsquare.com/files/rs-9060236/v1/a723c8adc722de7bc4eb3798.png"},{"id":104689987,"identity":"dcd20cfd-6932-4d35-87cd-1da424776e6a","added_by":"auto","created_at":"2026-03-16 06:03:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72296,"visible":true,"origin":"","legend":"\u003cp\u003eDynamic changes in SBP and DBP within 48 hours after the initial onset of severe acute hypertension. (A) Trends of SBP over time; (B) Trends of DBP over time. Data points represent medians with interquartile ranges. The numerical values displayed near each marker indicate the median values.\u003c/p\u003e\n\u003cp\u003eAbbreviations: SBP, Systolic Blood Pressure; DBP, Diastolic Blood Pressure\u003c/p\u003e","description":"","filename":"Binder32.png","url":"https://assets-eu.researchsquare.com/files/rs-9060236/v1/2d53c674fc01b9b950e99335.png"},{"id":104689990,"identity":"974725ed-03db-44bd-be41-775086d3b27f","added_by":"auto","created_at":"2026-03-16 06:03:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":244888,"visible":true,"origin":"","legend":"\u003cp\u003eRestricted cubic spline (RCS) curves for blood pressure parameters and 30-day mortality. Non-linear associations between four blood pressure metrics—(A) SBP-1h, (B) DBP-1h, (C) SBP-PR, and (D) DBP-PR—and the risk of 30-day mortality, based on the multivariable-adjusted Cox proportional hazards model (Model 2). Solid lines representing estimated hazard ratios are overlaid on histograms displaying the distribution of the total patient population and mortality events. To ensure statistical stability and visual clarity, the graphical representation is restricted to the 1st to 99th percentile range of each independent variable, minimizing the influence of extreme outliers.\u003c/p\u003e\n\u003cp\u003eAbbreviations: RCS, Restricted Cubic Splines; DBP, Diastolic Blood Pressure; SBP-1h, Achieved Systolic Blood Pressure at 1 hour; DBP-1h, Achieved Diastolic Blood Pressure at 1 hour; SBP-PR, Systolic Blood Pressure Percentage Reduction; DBP-PR, Diastolic Blood Pressure Percentage Reduction; HR, Hazard Ratio; CI, Confidence Interval.\u003c/p\u003e","description":"","filename":"Binder33.png","url":"https://assets-eu.researchsquare.com/files/rs-9060236/v1/31a152871757dd789a42f21c.png"},{"id":104808777,"identity":"09932098-b779-4c2b-962b-287204019064","added_by":"auto","created_at":"2026-03-17 12:39:57","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":132882,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curves stratified by blood pressure control targets.\u003c/p\u003e\n\u003cp\u003eKaplan–Meier curves illustrating 30-day mortality probabilities across different blood pressure management categories. Panels (A) and (B) display systolic parameters, with SBP-1h and SBP-PR each stratified into three subgroups based on the primary study thresholds (140/180 mmHg and 5%/25%, respectively). Panels (C) and (D) display diastolic parameters, with DBP-1h and DBP-PR each stratified into two subgroups based on their respective binary thresholds (70 mmHg and 27%). Log-rank tests were performed to compare survival distributions among the groups.\u003c/p\u003e","description":"","filename":"Binder34.png","url":"https://assets-eu.researchsquare.com/files/rs-9060236/v1/5951f043e7791b06d09ee27b.png"},{"id":104809800,"identity":"6f2e3c3d-7a1d-48fb-a777-0b90f94c6042","added_by":"auto","created_at":"2026-03-17 12:53:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1752084,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9060236/v1/76cb593b-1254-4e49-8d5f-6d512d7292e8.pdf"},{"id":104689988,"identity":"4fd1ec35-0078-40fc-bc73-1e9f6bc46d76","added_by":"auto","created_at":"2026-03-16 06:03:51","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":524307,"visible":true,"origin":"","legend":"Supplemental Material","description":"","filename":"SupplementaryMaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9060236/v1/372c1662d7ff567cc18bfb90.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Impact of Early Blood Pressure Reduction on Prognosis in ICU Patients with Severe Acute Hypertension: A Retrospective Study of the Medical Information Mart for Intensive Care IV (MIMIC-IV) Database","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMarked and abrupt elevations in blood pressure (BP) are common and often unpredictable in hospitalized patients\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, and are associated with adverse clinical outcomes, particularly increased short-term mortality\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. This concern is especially relevant in the intensive care unit (ICU), where patients are hemodynamically unstable and frequently experience rapid BP fluctuations. Although substantial evidence and well-established guidelines support long-term BP targets for chronic hypertension\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, considerably less attention has been directed toward optimal short-term BP control in the acute setting.\u003c/p\u003e \u003cp\u003eIn acute care, timely BP reduction is essential to prevent target organ damage (TOD), minimize the risk of hypertensive rebound, and allow safe clinical monitoring and therapeutic adjustment. For critically ill ICU patients, BP variability over short intervals is common, and determining an appropriate target range may be more clinically consequential than the selection of a specific antihypertensive agent\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Moreover, the complexity of critical illness and the high burden of comorbidities necessitate individualized BP management strategies tailored to diverse clinical scenarios\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious studies have primarily examined BP elevations in postoperative states, intracranial hemorrhage, or acute ischemic stroke\u003csup\u003e\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. However, a universally applicable BP target for asymptomatic but markedly elevated BP in the ICU has not been established. Most available evidence supports gradual BP reduction under close monitoring\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Current guidelines provide time-dependent BP targets, ranging from 1-hour to 24-48-hour intervals, for hypertensive emergencies (HE), along with distinct recommendations for BP management in acute ischemic stroke. Nevertheless, these recommendations are not readily generalizable to critically ill ICU patients without overt acute TOD\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eImportantly, guideline recommendations employ heterogeneous approaches, incorporating both percentage-based BP reductions and absolute BP thresholds, with a primary emphasis on systolic BP (SBP)In contrast, clinical studies often stratify patients according to achieved post-treatment BP values. This inconsistency highlights the need to clarify optimal BP targets in the early treatment phase. Specifically, it remains essential to define both the appropriate absolute BP levels and the magnitude of BP reduction within the critical first hour following severe acute hypertension.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eData source and study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were obtained from version 3.1 of the Medical Information Mart for Intensive Care IV (MIMIC-IV; https://mimic.mit.edu/), a large, publicly available, de-identified critical care database containing records from 94 458 ICU admissions between 2 008 and 2 022. Use of the database has been reviewed and approved by the Institutional Review Board of Beth Israel Deaconess Medical Center\u003csup\u003e14\u003c/sup\u003e. One author (certification ID: 665 79692) was granted credentialed access and performed the data extraction. We excluded ICU readmissions (\u003cem\u003en\u003c/em\u003e = 29 117), patients aged \u0026lt;18 or \u0026gt;100 years (\u003cem\u003en\u003c/em\u003e = 0), and ICU length of stay (LOS) \u0026lt; 24 hours (\u003cem\u003en\u003c/em\u003e = 13 362). Among the remaining 51 979 unique ICU admissions, all recorded BP measurements during the ICU stay were screened. A total of 6 713 patients experienced at least one episode of severe acute hypertension, defined as an index systolic blood pressure (SBP-index) \u0026ge;180 mmHg with at least one subsequent BP measurement documented within 1 hour. To reduce clinical heterogeneity, we further excluded patients with compelling indications for condition-specific BP management according to current guidelines, including hypertensive emergencies, pregnancy, intracranial hemorrhage, acute ischemic stroke, aortic dissection, and pheochromocytoma crisis. After applying these criteria, 4 895 patients comprised the final study cohort. The detailed selection process is shown in Figure 1. The study was conducted in accordance with the Declaration of Helsinki. Given the fully de-identified nature of the MIMIC-IV database, the requirement for informed consent was waived.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eData extraction and definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline data were extracted using PostgreSQL (version 17.1.12). Retrieved variables included demographic characteristics, laboratory results, ICU severity scores, medication exposure, comorbidities, surgical history, and survival outcomes. For variables with \u0026lt;10% missing data, multiple imputation by chained equations was used to address missingness. All longitudinal BP measurements and their corresponding timestamps throughout the ICU stay were extracted to characterize BP trajectories. Compelling indications requiring specialized BP management, as well as baseline comorbidities, were identified using International Classification of Diseases, Ninth and Tenth Revision codes (Table S1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBP data processing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBP measurements and timestamps were processed using Python (version 3.10.11). Each occurrence of SBP \u0026ge;180 mmHg was identified as an episode of severe acute hypertension. The index BP was defined as the earliest recorded BP at the onset of a qualifying episode (SBP-index and DBP-index). The achieved BP was defined as the last BP measurement recorded within the subsequent 1-hour window (SBP-1h and DBP-1h). \u003c/p\u003e\n\u003cp\u003eIf no follow-up BP measurement was available within 1 hour of the initial episode, subsequent qualifying episodes were sequentially evaluated until an eligible episode with adequate follow-up data was identified.\u003c/p\u003e\n\u003cp\u003eThe percentage reduction in BP was calculated as follows:\u003c/p\u003e\n\u003cp\u003eSBP-PR = [(SBP-index - SBP-1h) / SBP-index] \u0026times; 100%\u003c/p\u003e\n\u003cp\u003eDBP-PR = [[(DBP-index - DBP-1h) / DBP-index] \u0026times; 100%\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStudy endpoints\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary endpoint was 30-day all-cause mortality. Follow-up began at the time of the index episode of severe acute hypertension.\u003c/p\u003e\n\u003cp\u003eSecondary endpoints included in-hospital acute clinical events indicative of TOD: Neurological dysfunction is defined as coma, indicated by a Glasgow Coma Scale score \u0026lt;915 .Renal dysfunction is defined as Stage 3 acute kidney injury (AKI) according to the Kidney Disease: Improving Global Outcomes criteria16.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were conducted using R (version 4.5.0). Baseline characteristics were compared between 30-day survivors and non-survivors. Categorical variables are presented as counts and percentages and were compared using the chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. Continuous variables are expressed as medians with interquartile ranges and were compared using the Student\u0026rsquo;s t test or Wilcoxon rank-sum test, depending on data distribution. Restricted cubic spline (RCS) models were used to assess and visualize potential non-linear associations between BP control parameters and 30-day all-cause mortality, with BP variables modeled as continuous measures. For SBP parameters, survival differences across clinically relevant strata were evaluated using Kaplan-Meier curves and compared with the log-rank test. Cox proportional hazards models were applied to estimate hazard ratios (HRs). For diastolic blood pressure (DBP) parameters, ROC curve analysis was performed to identify optimal thresholds for risk stratification, followed by survival analyses based on these cutoffs. Multivariable logistic regression models were used to examine the associations between BP control levels and secondary endpoints, including Stage 3 AKI and coma. Because the date of death in the database is recorded in days, whereas the onset of severe acute hypertension is timestamped in hours, a small number of patients who died on the same calendar day as the index episode had calculated survival times of zero or slightly negative values. To meet the non-negative time requirement for survival analysis, these survival times were reassigned to 0.1 days in accordance with standard statistical practice. Cox regression results are reported as hazard ratios (HRs), and logistic regression results as odds ratios (ORs), both with 95% confidence intervals (CIs). A two-sided\u003cem\u003e P \u003c/em\u003evalue \u0026lt; 0.05 was considered statistically significant. Multivariable models were specified as follows:\u003c/p\u003e\n\u003cp\u003eModel 0: Unadjusted.\u003c/p\u003e\n\u003cp\u003eModel 1: Adjusted for sex, age, and ethnicity.\u003c/p\u003e\n\u003cp\u003eModel 2: Adjusted for Model 1 covariates plus comorbidities (myocardial infarction, heart failure, diabetes, renal disease, cerebrovascular disease, malignant tumor, peripheral vascular disease, chronic obstructive pulmonary disease (COPD), severe liver disease, rheumatic disease, pre-existing hypertension, and prior hypertension-related TOD), as well as sepsis, delirium, SBP-index, use of vasoactive agents, intravenous antihypertensive therapy, and timing of severe acute hypertension onset.\u003c/p\u003e\n\u003cp\u003eUnless otherwise specified, all reported results are based on Model 2.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics and BP dynamics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the 30-day follow-up period, 749 deaths occurred in the study cohort (364 females and 385 males). Compared with survivors, non-survivors were significantly older (73.39 vs. 67.15 years,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) and had a higher burden of comorbidities, including myocardial infarction (18.83% vs. 13.84%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), congestive heart failure (28.97% vs. 23.32%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.001), cerebrovascular disease (21.09% vs. 14.47%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), COPD (28.70% vs. 25.08%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.04), liver disease (6.68% vs. 4.20%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.004), and malignant cancer (18.83% vs. 12.47%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring the ICU stay, non-survivors were more likely to develop Stage 3 AKI (46.06% vs. 23.56%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), sepsis (80.37% vs. 56.87%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), coma (17.49% vs. 7.86%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), and delirium (43.66% vs. 37.39%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.001). Accordingly, they required more intensive organ support, including continuous renal replacement therapy (15.35% vs. 6.08%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), mechanical ventilation (87.32% vs. 82.63%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.001), and vasoactive agents (54.07% vs. 31.21%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNotably, intravenous antihypertensive therapy was administered less frequently in non-survivors (52.60% vs. 67.75%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), and pre-existing hypertension was less prevalent in this group (72.36% vs. 79.88%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eRegarding BP profiles, baseline SBP (131 vs. 141 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) and baseline DBP (69 vs. 72 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) were significantly lower among non-survivors. Similarly, mean SBP (129.22 vs. 136.90 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) and mean DBP (62.29 vs. 67.84 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) during the ICU stay were lower in the mortality group. In contrast, maximum SBP was slightly higher in non-survivors (196 vs. 192 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eThe onset of severe acute hypertension occurred significantly later in non-survivors compared with survivors (80.93 hours vs. 40.27 hours from ICU admission,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001). At the index episode, SBP was marginally higher (187 vs. 186 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.004), whereas DBP was slightly lower (86 vs. 87 mmHg,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.002) in patients who died. One hour after the episode, achieved BP levels were consistently lower in non-survivors (SBP-1h: 147 vs. 155 mmHg; DBP-1h: 67 vs. 73 mmHg; both\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) (Table 1; Table S2).\u003c/p\u003e\n\u003cp\u003eThe most pronounced BP reduction occurred within the first hour following the onset of severe acute hypertension. Median SBP decreased from 186 mmHg to 154 mmHg, and median DBP decreased from 87 mmHg to 72 mmHg (Figure 2A-B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between BP Control and 30-day mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRCS analyses were performed to characterize the associations between BP control parameters and 30-day mortality. A significant U-shaped relationship was observed between mortality and both SBP-1h (Figure 3A) and SBP-PR (Figure 3C). The nadirs of the spline curves corresponded to an SBP-1h of approximately 156.76 mmHg and an SBP-PR of 14.87%, suggesting these values as potential optimal targets (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, no clear U-shaped association was identified between mortality and either DBP-1h (Figure 3B) or DBP-PR (Figure 3D). Nevertheless, a consistent trend indicated that excessive reductions in DBP were associated with increased mortality risk, particularly at lower achieved DBP levels and higher reduction percentages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of SBP-1h and SBP-PR on mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further evaluate prognostic implications, patients were stratified according to SBP-1h and SBP-PR categories (Tables 3 and 4). Using SBP-1h \u0026ge;180 mmHg as the reference group, patients whose SBP-1h was maintained between 140 and 180 mmHg demonstrated a significant survival advantage (Table S8). The most pronounced benefit was observed in patients with SBP-1h between 150 and 160 mmHg (HR 0.62, 95% CI 0.46-0.82,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) and between 160 and 170 mmHg (HR 0.62, 95% CI 0.47-0.83,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.001).\u003c/p\u003e\n\u003cp\u003eSimilarly, when stratified by reduction magnitude, patients with no SBP reduction (SBP-PR \u0026le;0%) served as the reference group. An SBP-PR between 5% and 25% was associated with a significantly lower risk of 30-day mortality (Table S9). Notably, an SBP-PR of 15-20% conferred the greatest survival benefit (HR 0.56, 95% CI 0.39-0.80,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.002). Kaplan-Meier curves further illustrated improved survival among patients whose SBP was controlled within these optimal ranges (Figure 4A-B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of DBP-1h and DBP-PR on mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were also stratified according to DBP-1h and DBP-PR. Compared with patients whose DBP-1h was \u0026ge;110 mmHg, those maintained within the 70-80 mmHg range experienced a significant survival benefit (HR 0.64, 95% CI 0.44-0.95,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.03) (Tables S6-S7). However, no specific DBP-PR category demonstrated a statistically significant survival advantage in categorical analyses.\u003c/p\u003e\n\u003cp\u003eTo further refine risk stratification, ROC curve analyses were performed (Figure S1; Table S3). The optimal prognostic thresholds were identified as 70 mmHg for DBP-1h and 27% for DBP-PR. Subsequent Kaplan-Meier analyses (Figure 4C-D) showed that patients with DBP-1h \u0026lt;70 mmHg or DBP-PR \u0026gt;27% had significantly higher mortality rates (P \u0026lt; 0.001). These associations were confirmed in multivariable Cox proportional hazards models (Tables S10-S11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between BP targets and secondary endpoints\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe effects of SBP control categories on secondary endpoints, coma and Stage 3 AKI, were further examined. RCS analyses demonstrated U-shaped relationships between both SBP-1h and SBP-PR and the incidence of these complications (Figures S2-S3; Table S4).\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression models were used to quantify the risks associated with excessive or insufficient BP reduction. Using SBP-1h 140-180 mmHg as the reference category, patients with SBP-1h \u0026lt;140 mmHg had a significantly increased risk of Stage 3 AKI (OR 1.19, 95% CI 1.02-1.40,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.03) and a borderline higher risk of coma (OR 1.25, 95% CI 1.00-1.56,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.05). Similarly, compared with an SBP-PR of 5%-25%, an SBP-PR \u0026gt;25% was associated with a higher risk of Stage 3 AKI (OR 1.23, 95% CI 1.04-1.45,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.01) (Tables S12-S15).\u003c/p\u003e\n\u003cp\u003eFor diastolic parameters, a DBP-1h \u0026lt;70 mmHg was associated with a significantly greater incidence of Stage 3 AKI compared with DBP-1h \u0026ge;70 mmHg (OR 1.18, 95% CI 1.02-1.36,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.03). However, no significant association was observed between DBP categories and the occurrence of coma (Tables S16-S19). .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociations between covariates and clinical outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssociations between additional covariates and clinical outcomes are presented in Table S5. The multivariate analysis identified sepsis as a major independent predictor of 30-day mortality (HR 2.03, 95% CI 1.71-2.42, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001). Additionally, onset timing \u0026gt; 24h was associated with an increased risk of death (HR 1.44, 95% CI 1.23-1.68, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Conversely, the administration of intravenous antihypertensive therapy appeared to confer a survival benefit, significantly lowering the risk of mortality (HR 0.72, 95% CI 0.61-0.85,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this large real-world cohort of 4 895 critically ill patients from the MIMIC-IV database, we found that achieving BP within an optimal range during the first hour after a severe acute hypertensive episode was associated with a significant reduction in 30-day mortality. In contrast, excessive BP lowering was associated not only with increased mortality but also with a higher incidence of acute complications, including coma and Stage 3 AKI. These associations remained robust after adjustment for key confounders, including demographic characteristics and comorbid conditions. Importantly, our findings consistently highlight the relevance of both systolic and diastolic parameters. Similar conclusions were obtained whether BP control was assessed using absolute achieved values (e.g., SBP-1h) or percentage reductions (e.g., SBP-PR). The spline analyses identified optimal targets of approximately 156.76 mmHg for SBP-1h and 14.87% for SBP-PR, with clinically meaningful benefit observed within broader ranges of 140\u0026ndash;180 mmHg and 5%-25%, respectively. Notably, the adverse associations of excessive SBP reduction with coma and Stage 3 AKI were more pronounced than those observed with insufficient SBP reduction, suggesting the potential harm of overaggressive BP lowering in critically ill patients. With respect to diastolic BP, a DBP-1h\u0026thinsp;\u0026lt;\u0026thinsp;70 mmHg or a DBP-PR\u0026thinsp;\u0026gt;\u0026thinsp;27% was associated with increased 30-day mortality. These findings further emphasize the need to avoid excessive diastolic hypotension during early BP management, as diastolic perfusion pressure may be particularly critical for maintaining coronary and end-organ blood flow in vulnerable ICU populations.\u003c/p\u003e \u003cp\u003eThe 2 025 guidelines from the American Heart Association recommend that in patients with HE, SBP should be reduced by no more than 25% within the first hour, followed by a target of approximately 160/100 mmHg over the subsequent 2\u0026ndash;6 hours\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Similarly, the 2 024 guidelines from the European Society of Cardiology advise lowering SBP to \u0026lt;\u0026thinsp;180 mmHg within the first hour\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Although the clinical scenarios addressed in these guidelines differ from the population examined in our study, the numerical targets identified in our analysis are notably consistent with these recommendations. According to the 2 024 American Heart Association Scientific Statement, the patients included in our cohort would be classified as having hypertensive urgency (HU), or asymptomatic markedly elevated inpatient BP\u003csup\u003e17\u003c/sup\u003e. Current guidelines provide limited direction regarding specific BP reduction targets for this population, instead emphasizing the potential harm associated with overly aggressive BP lowering\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Despite HU being considerably more prevalent than HE\u003csup\u003e2\u003c/sup\u003e, it has received substantially less investigative attention\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Our findings help address this gap by providing empirical data to inform BP management in this clinically ambiguous \u0026ldquo;gray zone.\u0026rdquo; Moreover, guideline recommendations primarily focus on SBP, with relatively little emphasis on DBP. Some studies circumvent SBP-DBP discrepancies by using mean arterial pressure as a composite measure\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. In contrast, our study separately evaluated systolic and diastolic parameters and identified clinically relevant DBP thresholds. These results offer a foundation for future prospective studies and randomized controlled trials aimed at refining early BP targets in critically ill patients.\u003c/p\u003e \u003cp\u003eThe adverse consequences of abrupt BP elevation are largely mediated by the risk of acute TOD. Compared with HU, HE carries a higher immediate mortality risk because TOD is already present\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Nevertheless, both conditions share a common pathophysiological basis: a sudden increase in systemic vascular resistance. This elevation can induce microvascular injury, activate the renin-angiotensin-aldosterone system (RAAS), promote systemic vasoconstriction, and trigger pressure natriuresis with subsequent volume depletion, thereby establishing a feed-forward cycle that further aggravates hypertension. Although autoregulatory mechanisms in vital organs typically buffer transient BP fluctuations, failure of these mechanisms may result in serious complications such as cerebral edema, intracranial hemorrhage, acute heart failure, and AKI\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Importantly, overly rapid pharmacologically induced BP reduction may be equally harmful\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Prior studies have suggested that intravenous antihypertensive therapy in patients with severe acute hypertension may increase the risk of AKI\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In our cohort, the observed associations between excessive BP reduction and higher incidences of coma and Stage 3 AKI support this concern. These findings provide a plausible mechanistic explanation for the increased mortality observed in patients with overaggressive BP control. A key limitation of this study, however, is the inability to definitively determine the temporal sequence between BP elevation episodes and the onset of subsequent clinical events, which precludes firm conclusions regarding causality.\u003c/p\u003e \u003cp\u003eManagement strategies for HE, as well as for specific high-risk conditions, including pregnancy-related hypertension, intracranial hemorrhage, acute ischemic stroke, aortic dissection, and pheochromocytoma crisis, have been extensively investigated and are supported by established clinical consensus\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. These populations differ substantially from the cohort examined in our study and may independently influence secondary outcomes such as AKI or neurological dysfunction. To minimize confounding, these patients were excluded from the present analysis. Just as HE encompasses heterogeneous patterns of organ injury and clinical trajectories\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, HU likely represents a similarly heterogeneous entity. Future studies should therefore aim to refine BP targets according to precipitating factors, underlying etiologies, and specific patterns of TOD.\u003c/p\u003e \u003cp\u003eThe critically ill population included in this study possesses distinctive clinical features. Unlike patients in the general ward or community setting, who often present to the emergency department with overt TOD, facilitating the diagnosis of HE and prompting symptom-driven intravenous antihypertensive therapy, the ICU environment allows for continuous and high-resolution hemodynamic monitoring. This enables earlier identification of severe acute hypertension, frequently before overt organ injury develops. However, management in the ICU is complicated by severe comorbid conditions, fluctuating hemodynamics, and often lower baseline MAP\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, making early recognition of progression to HE more challenging when relying solely on integrated clinical signs\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Importantly, our findings suggest that the timing of severe acute hypertension onset has prognostic significance. Mortality was substantially higher among patients whose hypertensive episodes occurred more than 24 hours after ICU admission. This temporal pattern resembles that observed with certain postoperative complications, in which delayed onset is often associated with worse outcomes\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. A comparable analogy can be drawn to the distinction between community-acquired and hospital-acquired pneumonia\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, where timing reflects differences in underlying pathophysiology and risk profile. In severe acute hypertension, delayed onset may indicate a greater contribution from iatrogenic or in-hospital factors. Given that severe acute hypertension is influenced by diverse precipitating factors and prognostic determinants\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, optimal control strategies should be tailored accordingly. These areas represent critical directions for future investigation.\u003c/p\u003e \u003cp\u003eThis study provides an overall characterization of intravenous antihypertensive use during episodes of severe acute hypertension. Importantly, our primary objective was to evaluate therapeutic BP targets rather than the specific pharmacologic agents used to achieve them. Although intravenous antihypertensive administration was documented, the precise temporal relationship between drug delivery and the onset of BP elevation could not be definitively established. In addition, we did not perform a direct comparison between oral and intravenous antihypertensive agents. This was partly due to inherent limitations of the database and, more importantly, because such comparisons were beyond the scope of the present investigation.\u003c/p\u003e \u003cp\u003eNumerous clinical studies, including several well-designed randomized controlled trials, have examined pharmacologic strategies for BP management\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, particularly in conditions secondary to acute hypertension, such as intracranial hemorrhage\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. However, substantial inter-patient heterogeneity complicates efforts to simultaneously standardize medication dosing and predefined BP targets. As a result, establishing a direct causal relationship between specific antihypertensive agents and clinical outcomes remains challenging\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In routine clinical practice, pharmacologic therapy must be individualized according to each patient\u0026rsquo;s overall condition, comorbidity profile, and hemodynamic status\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. These complexities highlight important directions for future research.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this cohort of 4 895 critically ill patients with severe acute hypertension from the MIMIC-IV database, maintaining SBP-1h within 140\u0026ndash;180 mmHg or achieving an SBP-PR of 5%-25% was associated with significantly improved clinical outcomes compared with persistently uncontrolled SBP. In contrast, an SBP-1h\u0026thinsp;\u0026lt;\u0026thinsp;140 mmHg, SBP-PR\u0026thinsp;\u0026gt;\u0026thinsp;25%, DBP-1h\u0026thinsp;\u0026lt;\u0026thinsp;70 mmHg, or DBP-PR\u0026thinsp;\u0026gt;\u0026thinsp;27% were independently associated with increased mortality and a higher incidence of adverse events, including coma and Stage 3 AKI. These findings suggest that moderate early BP reduction confers clinical benefit, whereas overly aggressive BP lowering may compromise end-organ perfusion and worsen prognosis in the ICU setting.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eACKNOWLEDGEMENTS\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the participants in the Medical Information Mart for Intensive Care-IV database and to all those who participated in the study.\u003c/p\u003e\n\u003cp\u003eAUTHOR CONTRIBUTIONS\u003c/p\u003e\n\u003cp\u003eYunqing Li, Weiwei Zhu took part in the study design, performed statistical analyses and drafted the manuscript. Yunqing Li, Yixin He and Weiqi Yang had the access permission to MIMIC-IV 3.0 and extracted data for the present study. Qishan Chen, Mei Yang, Weiguo Zhu and Li Zhang conceived of the study and revised the manuscript critically for important intellectual content.\u003c/p\u003e\n\u003cp\u003eFUNDING\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eAVAILABILITY OF DATA AND MATERIALS\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe data in the MIMIC-IV public database have passed the ethical review of the original study, and no further ethical review and informed consent is required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCONSENT FOR PUBLICATION\u003c/p\u003e\n\u003cp\u003eAll authors have consented to the publication of the paper.\u003c/p\u003e\n\u003cp\u003eCOMPETING INTERESTS\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDesta DM, Wondafrash DZ, Tsadik AG, et al. Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study. Integr Blood Press Control. 2 020 Aug 18;13:95-102. doi: 10.2 147/IBPC.S265 183. PMID: 329 04390; PMCID: PMC745 5594.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePaini A, Tarozzi L, Bertacchini F, et al. Cardiovascular prognosis in patients admitted to an emergency department with hypertensive emergencies and urgencies. J Hypertens. 2 021 Dec 1;39(12):2 514-2 520. doi: 10.1 097/HJH.000 000000 0002 961. PMID: 344 20015; PMCID: PMC969 8186.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eManning L, Robinson TG, Anderson CS. Control of blood pressure in hypertensive neurological emergencies. Curr Hypertens Rep. 2 014 Jun;16(6):436. doi: 10.1 007/s11 906-014-0 436-x. PMID: 247 71058.\u003c/li\u003e\n \u003cli\u003eJones DW, Ferdinand KC, Taler SJ, et al. 2 025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2 025.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZanchetti A, Thomopoulos C, Parati G. Randomized controlled trials of blood pressure lowering in hypertension: a critical reappraisal. Circ Res. 2 015 Mar 13;116(6):1 058-73. doi: 10.1 161/CIRCRESAHA.116.303 641. PMID: 257 67290.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMcEvoy JW, McCarthy CP, Bruno RM, et al. 2 024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2 024;45(38):3 912-4 018. doi:10.1 093/eurheartj/ehae178.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePerez MI, Musini VM. Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review. J Hum Hypertens. 2 008 Sep;22(9):596-607.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eD\u0026apos;Amico F, Pruna A, Putowski Z, et al. Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients: A Systematic Review and Meta-Analysis. Crit Care Med. 2 024.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eQureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2 016;375(11):1 033-43.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAnderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2 013;368(25):2 355-65.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLee M, Ovbiagele B, Hong KS, et al. Effect of Blood Pressure Lowering in Early Ischemic Stroke: Meta-Analysis. Stroke. 2 015;46(7):1 883-9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMiller JB, Calo S, Reed B, et al. Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency. Am J Emerg Med. 2 019.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGhazi L, Chen X, Harhay MO, et al. Treatment Effect Heterogeneity in Acute Kidney Injury Incidence Following Intravenous Antihypertensive Administration for Severe Blood Pressure Elevation During Hospitalization. Am J Kidney Dis. 2 025.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJohnson AEW, Bulgarelli L, Shen L, et al. MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2 023;10(1):1.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTeasdale G, Maas A, Lecky F, et al. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2 014 Aug;13(8):844-54. doi: 10.1 016/S1 474-4 422(14)70 120-6. Erratum in: Lancet Neurol. 2 014 Sep;13(9):863. PMID: 250 30516.\u003c/li\u003e\n \u003cli\u003eKidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2 012;2(1):1-138. doi:10.1 038/kisup.2 012.1.\u003c/li\u003e\n \u003cli\u003eBress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. 2 024.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLevy PD, Mahn JJ, Miller J, et al. Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort. Am J Emerg Med. 2 015.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGhazi L, Li F, Chen X, et al. Severe inpatient hypertension prevalence and blood pressure response to antihypertensive treatment. J Clin Hypertens (Greenwich). 2 022.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAsfar P, Meziani F, Hamel JF, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2 014;370(17):1 583-93.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGuiga H, Decroux C, Michelet P, et al. Hospital and out-of-hospital mortality in 670 hypertensive emergencies and urgencies. J Clin Hypertens (Greenwich). 2 017.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVallelonga F, Cesareo M, Menon L, et al. Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO. Hypertens Res. 2 023.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMiller JB, Hrabec D, Krishnamoorthy V, et al. Evaluation and management of hypertensive emergency. BMJ. 2 024;386:e077 205.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSzczech LA, Granger CB, Dasta JF, et al. Acute kidney injury and cardiovascular outcomes in acute severe hypertension. Circulation. 2 010;121(20):2 183-91.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoca SG, Garg AX, Swaminathan M, et al. Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. Nephrol Dial Transplant. 2 013.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJohnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiol Clin. 2 012;30(4):533-43.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBihain F, Nomine-Criqui C, Guerci P, et al. Management of Patients with Treatment of Pheochromocytoma: A Critical Appraisal. Cancers (Basel). 2 022.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBenenson I, Waldron FA, Holly C. A Systematic Review and Meta-analysis of the Clinical and Epidemiological Characteristics of Patients with Hypertensive Emergencies. High Blood Press Cardiovasc Prev. 2 023.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWakeam E, Hyder JA, Tsai TC, et al. Complication timing and association with mortality in the American College of Surgeons\u0026apos; National Surgical Quality Improvement Program database. J Surg Res. 2 015 Jan;193(1):77-87. doi: 10.1 016/j.jss.2 014.08.025. Epub 2 014 Aug 21. PMID: 252 60955.\u003c/li\u003e\n \u003cli\u003eTorres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociaci\u0026oacute;n Latinoamericana del T\u0026oacute;rax (ALAT). Eur Respir J. 2 017 Sep 10;50(3):170 0582. doi: 10.1 183/139 93003.00 582-2 017. PMID: 288 90434.\u003c/li\u003e\n \u003cli\u003eGhazi L, Li F, Chen X, et al. Blood pressure response to commonly administered antihypertensives for severe inpatient hypertension. PLoS One. 2 022.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHe J, Zhang Y, Xu T, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA. 2 014;311(5):479-89. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline characteristics and comorbidities by 30-day survival condition in critically ill patients with severe acute hypertension.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 4895)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 4146)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-survivors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 749)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eMale, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e2 704 (55.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 319 (55.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e385 (51.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e68.08\u003c/p\u003e\n \u003cp\u003e(56.90 - 79.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e67.15\u003c/p\u003e\n \u003cp\u003e(56.43 - 78.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e73.39\u003c/p\u003e\n \u003cp\u003e(61.73 - 83.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eWhite, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e2 976 (60.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 544 (61.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e432 (57.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eMyocardial infarction, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e715 (14.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e574 (13.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e141 (18.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eCongestive heart failure, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 184 (24.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e967 (23.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e217 (28.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003ePeripheral vascular disease, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e575 (11.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e486 (11.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e89 (11.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eCerebrovascular disease, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e758 (15.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e600 (14.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e158 (21.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eCOPD, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 255 (25.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 040 (25.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e215 (28.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eRheumatic disease, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e189 (3.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e153 (3.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e36 (4.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eDiabetes, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 743 (35.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 515 (36.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e228 (30.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eRenal disease, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 209 (24.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 025 (24.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e184 (24.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eSevere liver disease, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e224 (4.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e174 (4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e50 (6.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eMalignant cancer, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e658 (13.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e517 (12.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e141 (18.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003ePre-existing hypertension, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e3 854 (78.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3 312 (79.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e542 (72.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eHypertensive TOD, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 450 (29.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 237 (29.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e213 (28.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn-hospital Complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eAKI, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e3 939 (80.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3 263 (78.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e676 (90.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eStage 3 AKI, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 322 (27.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e977 (23.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e345 (46.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eSepsis, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e2 960 (60.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 358 (56.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e602 (80.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eSevere coma, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e457 (9.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e326 (7.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e131 (17.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eDelirium, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 877 (38.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 550 (37.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e327 (43.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBP Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eSBP-baseline (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e139 (118 - 160)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e141 (119 - 161)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e131 (110 - 154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eDBP-baseline (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e71 (59 - 86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e72 (60 - 87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e69 (57 - 82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eTiming of severe acute hypertension onset (hour)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e50.66\u003c/p\u003e\n \u003cp\u003e(6.22 - 100.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e40.27\u003c/p\u003e\n \u003cp\u003e(5.08 - 96.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e80.93\u003c/p\u003e\n \u003cp\u003e(21 - 122.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eSBP-index (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e186 (182 - 193)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e186 (182 - 192)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e187 (182 - 194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eDBP-index (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e87 (75 - 101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e87 (75 - 101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e86 (71 - 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eSBP-1h (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e154 (133 - 172)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e155 (135 - 172)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e147 (121 - 170)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eDBP-1h (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e72 (60 - 86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e73 (61 - 87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e67 (55 - 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eIn-hospital mean SBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e135.75\u003c/p\u003e\n \u003cp\u003e(124.48 - 146.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e136.90\u003c/p\u003e\n \u003cp\u003e(125.72 - 146.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e129.22\u003c/p\u003e\n \u003cp\u003e(117.21 - 140.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eIn-hospital mean DBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e67.01\u003c/p\u003e\n \u003cp\u003e(59.59 - 75.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e67.84\u003c/p\u003e\n \u003cp\u003e(60.44 - 76.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e62.29\u003c/p\u003e\n \u003cp\u003e(55.75 - 69.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eIn-hospital max SBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e193 (185 - 205)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e192 (185 - 204)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e196 (187 - 210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eIn-hospital max DBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e117 (101 - 137)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e117 (101 - 137)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e114 (99 - 138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVital Signs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eHeart rate (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e87 (73 - 102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e86 (73 - 102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e89 (74 - 104)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eTemperature (℃)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e36.78\u003c/p\u003e\n \u003cp\u003e(36.44 - 37.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e36.78\u003c/p\u003e\n \u003cp\u003e(36.44 - 37.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e36.67\u003c/p\u003e\n \u003cp\u003e(36.33 - 37.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eRespiratory rate (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e19 (16 - 23.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e19 (15 - 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e20 (17 - 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatments\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eVentilator use, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e4 080 (83.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3 426 (82.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e654 (87.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eCRRT, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e367 (7.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e252 (6.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e115 (15.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eAntihypertensive medications, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e4 569 (93.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3 895 (93.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e674 (89.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eIntravenous antihypertensive agents, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e3 203 (65.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 809 (67.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e394 (52.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eVasoactive agents, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 699 (34.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 294 (31.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e405 (54.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Stay (day)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e10.02\u003c/p\u003e\n \u003cp\u003e(5.74 - 18.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e10.33\u003c/p\u003e\n \u003cp\u003e(5.87 - 18.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e8.86\u003c/p\u003e\n \u003cp\u003e(4.71 - 14.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: SBP, Systolic Blood Pressure; SBP-index, Index Systolic Blood Pressure; SBP-1h, Achieved Systolic Blood Pressure at 1 hour; SBP-PR, Systolic Blood Pressure Percentage Reduction; DBP, Diastolic Blood Pressure; DBP-index, Index Diastolic Blood Pressure; DBP-1h, Achieved Diastolic Blood Pressure at 1 hour; DBP-PR, Diastolic Blood Pressure Percentage Reduction; COPD, Chronic Obstructive Pulmonary Disease; TOD, Target Organ Damage; HHD, Hypertensive Heart Disease; HKD, Hypertensive Kidney Disease; AKI, Acute Kidney Injury; CRRT, Continuous Renal Replacement Therapy; RAASi, Renin\u0026ndash;Angiotensin\u0026ndash;Aldosterone System Inhibitors; CCB, Calcium Channel Blockers; SNP, Sodium Nitroprusside; SCr, Serum Creatinine; WBC, White Blood Cell Count; Hb, Hemoglobin; LOS, Length of Stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Identification of optimal blood pressure control targets within the first hour for 30-day mortality from Restricted Cubic Spline Analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBP Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNadir Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSBP-1h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e156.76 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDBP-1h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.63 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSBP-PR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.87%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 293px;\"\u003e\n \u003cp\u003eDBP-PR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: SBP-1h, Achieved Systolic Blood Pressure at 1 hour; SBP-PR, Systolic Blood Pressure Percentage Reduction; DBP, Diastolic Blood Pressure; DBP-1h, Achieved Diastolic Blood Pressure at 1 hour; DBP-PR, Diastolic Blood Pressure Percentage Reduction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Multivariate Cox proportional hazards analysis of achieved systolic blood pressure (SBP-1h) and 30-day mortality.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"588\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSBP-1h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of events\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModel 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge; 180 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e170 mmHg - 180 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.71 (0.54, 0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160 mmHg - 170 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.71 (0.53, 0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 mmHg - 160 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.75 (0.57, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140 mmHg - 150 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.79 (0.59, 1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 mmHg - 140 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.03 (0.77, 1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 mmHg - 130 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.08 (0.78, 1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 120 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.61 (1.27, 2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge; 180 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e170 mmHg - 180 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.71 (0.54, 0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160 mmHg - 170 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.70 (0.53, 0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 mmHg - 160 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.76 (0.57, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140 mmHg - 150 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.79 (0.59, 1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 mmHg - 140 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.04 (0.78, 1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 mmHg - 130 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.09 (0.79, 1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 120 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.65 (1.30, 2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge; 180 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e170 mmHg - 180 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.68 (0.51, 0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160 mmHg - 170 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.62 (0.47, 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 mmHg - 160 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.62 (0.46, 0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140 mmHg - 150 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.66 (0.49, 0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 mmHg - 140 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.77 (0.58, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 mmHg - 130 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78 (0.56, 1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026lt; 120 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.05 (0.82, 1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRelationship between diastolic blood pressure percentage reduction and 30-day mortality, with SBP-1h categorized into eight subgroups based on thresholds of 120mmHg, 130mmHg, 140mmHg, 150mmHg, 160mmHg, 170mmHg, and 180mmHg. The group with SBP-1h \u0026ge; 180mmHg serves as the reference. In model 1, covariates included age, sex and race. In model 2, covariates included age, sex, race, comorbidities (myocardial infarction, heart failure, diabetes, renal disease, cerebrovascular disease, malignant tumor, peripheral vascular disease, chronic pulmonary disease (COPD), severe liver disease, rheumatic disease, pre-existing hypertension, and prior TOD due to hypertension), sepsis, delirium, SBP-index, the use of vasoactive agents, intravenous antihypertensive therapy, and the timing of severe acute hypertension onset.\u003c/p\u003e\n\u003cp\u003eAbbreviations: BP, Blood Pressure; SBP, Systolic Blood Pressure; DBP, Diastolic Blood Pressure; SBP-index, Index Systolic Blood Pressure; SBP-1h, Achieved Systolic Blood Pressure at 1 hour; HR, Hazard Ratio; CI, Confidence Interval; COPD, Chronic Obstructive Pulmonary Disease; TOD, Target Organ Damage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Multivariate Cox proportional hazards analysis of systolic blood pressure percentage reduction (SBP-RR) and 30-day mortality.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\" class=\"fr-table-selection-hover\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSBP-PR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of events\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eModel 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026le; 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0% - 5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.05 (0.74, 1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e5% - 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.73 (0.52, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e10% - 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.89 (0.63, 1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e15% - 20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.72 (0.50, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e20% - 25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.80 (0.55, 1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e25% - 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.13 (0.80, 1.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026gt; 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1 249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.52 (1.14, 2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026le; 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0% - 5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.08 (0.76, 1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e5% - 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.72 (0.51, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e10% - 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.90 (0.64, 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e15% - 20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.73 (0.51, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e20% - 25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.80 (0.55, 1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e25% - 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.16 (0.81, 1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026gt; 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1 249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.56 (1.17, 2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026le; 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0% - 5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.95 (0.67, 1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e5% - 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.60 (0.43, 0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e10% - 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.79 (0.56, 1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e15% - 20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.56 (0.39, 0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e20% - 25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.63 (0.43, 0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e25% - 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.82 (0.57, 1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026gt; 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1 249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.96 (0.71, 1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRelationship between SBP-PR and 30-day mortality, with SBP-PR categorized into eight subgroups based on thresholds of 0, 5%, 10%, 15%, 20%, 25%, and 30%. The group with SBP-PR \u0026le; 0% serves as the reference. In model 1, covariates included age, sex and race. In model 2, covariates included age, sex, race, comorbidities (myocardial infarction, heart failure, diabetes, renal disease, cerebrovascular disease, malignant tumor, peripheral vascular disease, chronic pulmonary disease (COPD), severe liver disease, rheumatic disease, pre-existing hypertension, and prior TOD due to hypertension), sepsis, delirium, SBP-index, the use of vasoactive agents, intravenous antihypertensive therapy, and the timing of severe acute hypertension onset.\u003c/p\u003e\n\u003cp\u003eAbbreviations: BP, Blood Pressure; SBP, Systolic Blood Pressure; DBP, Diastolic Blood Pressure; SBP-index, Index Systolic Blood Pressure; RCS, Restricted Cubic Splines; DBP, Diastolic Blood Pressure; SBP-PR, Systolic Blood Pressure Percentage Reduction; AKI, Acute Kidney Injury; HR, Hazard Ratio; CI, Confidence Interval; COPD, Chronic Obstructive Pulmonary Disease; TOD, Target Organ Damage.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-human-hypertension","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jhh","sideBox":"Learn more about [Journal of Human Hypertension](http://www.nature.com/jhh/)","snPcode":"41371","submissionUrl":"https://mts-jhh.nature.com/cgi-bin/main.plex","title":"Journal of Human Hypertension","twitterHandle":"@jhhypertension","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Severe acute hypertension, blood pressure control, 30-day mortality, target organ damage, intensive care unit","lastPublishedDoi":"10.21203/rs.3.rs-9060236/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9060236/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSevere acute elevations in blood pressure (BP) are common among intensive care unit (ICU) patients and are associated with adverse clinical outcomes. This study investigated the association between early BP dynamics following severe acute hypertension and 30-day mortality. In this retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we included 4 895 ICU patients with severe acute hypertension, defined as at least one systolic blood pressure (SBP) measurement\u0026thinsp;\u0026ge;\u0026thinsp;180 mmHg. Restricted cubic spline (RCS) models were used to characterize the associations between 30-day mortality and four BP parameters measured 1 hour after the index episode: achieved systolic and diastolic BP (SBP-1h and DBP-1h) and their corresponding percent reductions (SBP-PR and DBP-PR). Survival analyses were conducted across predefined BP strata. The greatest reduction in BP occurred within the first hour after the index hypertensive episode. RCS analyses demonstrated U-shaped associations between 30-day mortality and both SBP-1h and SBP-PR, with nadirs at 156.76 mmHg for SBP-1h and 14.87% for SBP-PR. In multivariable Cox regression models, an SBP-1h of 140\u0026ndash;180 mmHg or an SBP-PR of 5%-25% was associated with a significant survival benefit. Conversely, a DBP-1h\u0026thinsp;\u0026lt;\u0026thinsp;70 mmHg or a DBP-PR\u0026thinsp;\u0026gt;\u0026thinsp;27% was associated with an increased risk of mortality. Among ICU patients with severe acute hypertension, maintaining BP within an optimal range during the early treatment period is associated with improved prognosis. Excessive reductions in either SBP or DBP are associated with increased 30-day mortality, highlighting the importance of avoiding overaggressive BP lowering in this population.\u003c/p\u003e","manuscriptTitle":"Impact of Early Blood Pressure Reduction on Prognosis in ICU Patients with Severe Acute Hypertension: A Retrospective Study of the Medical Information Mart for Intensive Care IV (MIMIC-IV) Database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-16 06:03:46","doi":"10.21203/rs.3.rs-9060236/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-28T06:55:29+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-04-16T06:21:01+00:00","index":1,"fulltext":"This content is not available."},{"type":"submitted","content":"Journal of Human Hypertension","date":"2026-03-16T13:54:10+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2026-03-16T11:26:19+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-11T12:30:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-09T15:48:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-07T18:10:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-human-hypertension","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jhh","sideBox":"Learn more about [Journal of Human Hypertension](http://www.nature.com/jhh/)","snPcode":"41371","submissionUrl":"https://mts-jhh.nature.com/cgi-bin/main.plex","title":"Journal of Human Hypertension","twitterHandle":"@jhhypertension","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"27c1cecc-e220-40b5-95db-db8ab308e950","owner":[],"postedDate":"March 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":64323010,"name":"Health sciences/Diseases/Cardiovascular diseases/Hypertension"},{"id":64323011,"name":"Health sciences/Health care/Prognosis"},{"id":64323012,"name":"Health sciences/Medical research/Clinical trial design"}],"tags":[],"updatedAt":"2026-03-16T06:03:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-16 06:03:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9060236","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9060236","identity":"rs-9060236","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}