Abstract Body: Introduction
Two of the most prevalent chronic medical conditions are diabetes and hypertension, often simultaneously occurring together. Long-term hyperglycemia may head to autonomic dysregulation, endothelial damage, and chronic inflammation that places patients with diabetes at increased risk of vascular and renal related complications when presenting with hypertensive crises. Despite the prevalence of these two conditions, there is limited data on the clinical outcomes of diabetic patients admitted with hypertensive emergency or urgency.

Methods
Patients admitted with the primary diagnosis of hypertensive crisis were identified using the 2021 National Inpatient Sample (NIS) and stratified based on the presence of type 1 and type 2 diabetes mellitus. Logistic and linear regression models were used to study the relationship between outcomes in patients with a history of diabetes who were hospitalized for hypertensive crisis, 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
In 2021, the NIS reported 140,695 adults were admitted with the primary diagnosis of hypertensive crisis. Of these, 14,725 had a concurrent diagnosis of diabetes. After adjusting for factors such as age, gender, insurance, income level, comorbidities, hospital region, location, and teaching status, there was increased age-related mortality in the study group. Each one-year increase in patients age was associated with a 4.3% increase in odds of mortality (aOR 1.04, 95% CI 1.02-1.07). The diabetes group was also found to have a shorter length of stay (aOR -0.36, 95% CI -0.48- -0.24) and decreased odds of renal replacement therapy (aOR 0.08, 95% CI 0.05-0.13). Female patients in the diabetes group had lower odds of mechanical ventilation compared to their counterparts (aOR 0.70, 95% CI 0.52-0.95). There was not a significant difference in total hospital charges between the two groups.

Conclusion
Our study showed that there was an age-related increase in mortality in patients with diabetes that were admitted with hypertensive crises. Paradoxically, the shorter length of stay and lower odds of renal replacement therapy may be explained by stricter chronic disease management, use of cardioprotective medications such as SGLT2-inibitors, and closer in-hospital monitoring.