Abstract Body: Introduction
Hypertensive emergencies require quick diagnosis and intervention. There is a well-established association between chronic hypertension and socioeconomic status, but there is limited data on the effects of social disparities on in-hospital presentations. The aim of this study was to investigate the impact of race, insurance status, and hospital setting on length of stay, total charges, renal replacement therapy, and mortality rates in patients presenting to the hospital with hypertensive emergency.

Methods
Patients admitted with the primary diagnosis of hypertensive emergency were identified using the 2021 National Inpatient Sample (NIS). Logistic and linear regression models were used for analysis, adjusting for confounding variables using the Charlson comorbidity index. A univariate screen with a p-value cutoff of less than 0.2 was performed followed by a multivariate analysis. The threshold for statistical significance was set at a 2-tailed p-value of 0.05.

Results
Of the patients admitted with a primary diagnosis of hypertensive emergency in 2021, length of stay was longer for the African American population compared to the Caucasian population (aOR 0.16, 95% CI 0.01-0.31) and Medicaid population (aOR 0.25, 95% CI 0.04-0.47) compared to private insurance. Compared to urban teaching hospitals, rural hospitals had decreased length of stay (aOR -0.25, 95% CI -0.49 – 0.00). The Hispanic population had higher total hospital charges (aOR 7586.07, 95% CI 4012.27 -11159.86). Additionally, there was increased odds of renal replacement therapy in the African American (aOR 1.93, 95% CI 1.64-2.29), Hispanic (aOR 2.45, 95% CI 1.99-3.00), and Asian (aOR 3.32, 95% CI 2.34-4.72) populations compared to the Caucasian population. Rural setting, insurance status, and race did not have significant associations with mechanical ventilation or mortality rates.

Conclusion
This study highlighted differences in length of stay, hospital charges, and odds of renal placement therapy when comparing insurance status, race, and hospital settings. These findings may be explained by differences in access to care, underdiagnosis, and delayed treatment of hypertension and its associated complications. Clinicians should help in establishing equitable strategies for prevention, management, and monitoring in patients with hypertension to ensure high quality care for patients of all socioeconomic backgrounds.