IMC Care Matches ICU Outcomes for Hypertensive Emergencies, Study Finds
Key Takeaways:
- Length of hospital stay was not different for patients admitted to an intermediate care (IMC) vs intensive care unit (ICU). The average duration was 4 days for both groups.
- Patients in the ICU received more monitorization, but this had little effect on clinical outcomes.
- Both IMC and ICU settings were effective at controlling blood pressure. Patients in either setting reached target blood pressures at similar times, indicating that setting type may not impact care management.
IMC units emerged as care settings for patients who require active monitoring but do not need the level of intervention provided at an ICU. Therefore, ICU resources can be preserved for sicker patients without compromising the care of those who do not qualify for intensive care. This retrospective observational study compared outcomes in IMC and ICU settings for patients with a hypertensive emergency.
The study evaluated patients admitted to 1 of 3 qualifying hospitals within the Johns Hopkins Health System who had 2 or more systolic blood pressure readings greater than 180 mm Hg within 12 hours of one another. Overall, the study assessed the outcomes of 1008 patients; 629 patients were admitted to an IMC setting and 649 patients were admitted to the ICU (4% of IMC patients were transferred to the ICU during the course of the study).
Patient Outcomes in ICU vs IMC Settings
Length of stay did not differ between settings. ICU patients were discharged after 4.8 days while IMC patients were discharged after 4.3 days. There was also no difference in odds of readmission after discharge or in-hospital death, suggesting that setting does not affect duration or outcome of hospital stay for patients with hypertensive emergencies.
Patients admitted to the ICU had blood pressure documented more frequently and remained on intravenous antihypertensives longer than those in IMC settings. However, the authors noted that “this is unlikely to affect clinical or operational outcomes in an important way.”
Both settings had comparable rates of controlling blood pressure. Time to target blood pressure was similar between the 2 settings, and both sets of patients achieved a blood pressure above goal between 6 and 24 hours after admission. However, episodes of hypotension were more common in patients in the ICU.
Clinical Implications
This study found no correlation between IMC admission and better/worse hospital stays. These findings imply that the type of setting may not directly impact outcomes for patients experiencing a hypertensive emergency. Further research is required to outline which patients can be safely managed in IMC settings without compromising their care.
Reference
Hochberg CH, Yan L, Card E, et al. Outcomes of patients with hypertensive emergency managed in intensive vs intermediate care settings: a multihospital retrospective cohort study. Ann Am Thorac Soc. 2026;23(4):565-574. doi:10.1093/annalsats/aaoaf048
