Hypertensive emergencies (HEs) are frequently accompanied with the release of cardiac troponin I (cTnI); however, determinants and clinical significance of cTnI elevation are largely unknown. A retrospective analysis was performed on patients (n=567) with a diagnosis of HE admitted to two tertiary care centers that primarily serve an inner-city population. Data on demographics, clinical variables, and cTnI were collected through chart review. Using regression analyses, predictors of cTnI elevation were studied and the impact of cTnI on all-cause mortality (data obtained through the Social Security Death Index) was determined. cTnI elevation was observed in 186 (32.3%) admissions with a mean peak cTnI level of 4.06AE14.6 ng ⁄ mL. Predictors of cTnI were age, history of hypercholesterolemia, blood urea nitrogen level, pulmonary edema, and requirement for mechanical ventilation. During a mean follow-up period of 3.1 years, there were 211 deaths (37%). Neither the presence nor the extent of cTnI elevation was associated with mortality, while age, history of coronary artery disease, and blood urea nitrogen level were predictive of mortality. cTnI elevation commonly occurs in the setting of HEs. Despite a high incidence of adverse clinical outcomes, cTnI elevation was not an independent predictor of mortality in this population. J Clin Hypertens (Greenwich). 2011;13:551-556. Ó2011 Wiley Periodicals, Inc.Approximately 72 million people in the United States are affected by hypertension (HTN).1 Hypertensive emergencies (HEs) are characterized by severe elevations in blood pressure (BP) (>180 ⁄ 120 mm Hg), complicated by new or worsening target organ dysfunction, and require immediate reduction in BP to limit end-organ damage. HEs account for 6% of all patients with clinical emergencies presenting to the emergency department. 2,3Patients with HEs frequently have elevations in cardiac biomarkers such as cardiac troponin I (cTnI), despite the absence of symptoms or electrocardiographic (ECG) changes suggesting myocardial infarction. 4,5 However, the importance of cardiac troponin release in HE is currently uncertain.cTnI is a sensitive and specific marker of myocardial cell injury and is of prognostic value in patients with acute coronary syndromes 6 and a variety of other critical care problems. 5,[7][8][9][10][11][12] The frequency, predictors, and clinical relevance of cTnI elevation in the setting of HEs are currently lacking.This study sought to specifically explore the prevalence, clinical determinants, and prognostic significance of cTnI release in patients presenting with HEs.