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Title: 2-Year Morbidity and Mortality due to Hypertensive Crisis in a Predominantly African American Population Hypertensive crisis (HTNC) is a complication of Hypertension with a prevalence of 1-2%. HTNC is defined by a sudden and unpredictable increase in systolic blood pressure of ≥180 mmHg or diastolic blood pressure of ≥120 mmHg. HTNC may present as hypertensive urgency (HTNU) if asymptomatic, or hypertensive emergency (HTNE) if there are signs of end organ damage (EOD) eg: stroke (CVA), congestive heart failure (CHF), acute kidney injury (AKI), acute myocardial infarction (AMI) and death. A 2y retrospective cohort study of 1100 participants: 550 cases and 550 hypertensive controls BP >140/90) but < 200/120, matched for race, sex, and age, was conducted to determine the incidence of EOD, and the 2year mortality. The population was: Blacks 481/550 (87.4%), White 18/550 (3.3%), Asian 2/550 (0.4%) and other 49 /550 (8.9%). The mean SBP for cases was SBP 209.7 (SD=23.1), controls 147.8(SD=22.8) p=0.239; DBP cases 115.5 (SD=22.4), controls 84.2 (SD=14.1) p<.001. The incidence of new EOD for CHF: HTNE=39/440 (9.8%), HTNU=8/150 (5.3%), controls=6/550 (1.1%), p<.001; AKI HTNE=27/400 (6.8%), HTNU=5/150 (6.7 %), controls=17/550 (3.1%) p<0.001; AMI HTNE=6.5% and HTNU=2.7% controls=6/550 (1.1%) p<.001. There was no significant difference in the incidence of hemorrhagic and ischemic CVA, but the trend was higher in HTNE and HTNC for ischemic CVA: HTNE=4/400 (1%), HTNU=1/150 (0.7%), controls=(0.2%) p=.234. The 2y mortality for HTNE=82/400 (20.5%), HTNU=16/150 (10.6%), controls= 36/550 (6.5 %). The odds of dying was 3.5 times greater in the HTNU (OR 3.5, 95% CI 1.78-6.98), p<.001) and 4.3 times in the HTNE population (OR 4.3, 95% CI 2.65-7.01), p<.001). The study reveals a high morbidity and mortality associated with hypertensive crisis, with 1/5 of the population of HTNE dying in two years, mostly from related cardiovascular disease and renal failure.