Abstract Body: Background:
Cocaine is a potent sympathomimetic associated with hypertensive crises and aortic dissection. Concerns about unopposed alpha-adrenergic stimulation have led to caution in beta-blocker use, though recent studies question this rationale. This study evaluates trends, demographic patterns, and outcomes in patients with cocaine-associated hypertensive emergencies and aortic dissection using a nationally representative database.
Methods:
Adult hospitalizations from the Nationwide Inpatient Sample (2016–2021) with diagnoses of aortic dissection, hypertensive emergency, and cocaine use disorder were analyzed. Logistic regression models adjusted for age, sex, race, and Charlson Comorbidity Index were used to assess associations with outcomes. Temporal trends were evaluated using year-wise regression.
Results:
Among 1,769,475 admissions with aortic dissection, 0.6% had documented cocaine use, and 0.1% had coexisting hypertensive emergency. The incidence of aortic dissection among patients with both cocaine use and hypertensive emergency was 2.3%, similar to 2.2% in those without cocaine use.
Cocaine use was associated with 2.33-fold higher odds of hypertensive emergency (p<0.001). While hypertensive emergency alone increased the odds of aortic dissection by 1.5-fold, the combination with cocaine increased the odds by 2.4-fold (p<0.001).
Patients with cocaine-associated hypertensive emergency were significantly younger (mean age 54 vs. 73 years, p<0.001) and less often female (25% vs. 32.3%). The odds of cocaine use, hypertensive emergency, and aortic dissection were 15.4 times higher among Black patients compared to Whites (p<0.001). In-hospital mortality was 21% lower in cocaine users with hypertensive emergency compared to non-users (p=0.03).
The odds of acute coronary syndrome were 43% lower in patients with both cocaine use and hypertensive emergency (p=0.03), while the odds of acute kidney injury were 1.2 times higher (p=0.036).
From 2016 to 2021, hypertensive emergencies in cocaine users rose by 23%, and aortic dissections increased by 11.1%—both statistically significant (p<0.001).
Conclusion:
Cocaine use disproportionately affects younger, Black, and male patients and significantly increases the risk of hypertensive emergency and aortic dissection. Despite greater acuity, lower mortality and ACS rates were observed, likely due to demographic factors. These findings challenge traditional management assumptions and warrant further prospective study.