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Blood pressure decrease prior to initiating pharmacological therapy in nonemergent hypertension
T Lebby1, F Paloucek, F Dela Cruz
1Department of Medicine, College of Medicine, Chicago, IL 60612.
Insights
In nonemergent hypertension cases, blood pressure naturally decreases in the emergency department (ED) before treatment. Observation is often sufficient, avoiding immediate pharmacological intervention.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Nonemergent hypertension management in the emergency department (ED) setting requires characterization.
- Understanding blood pressure trends before pharmacological therapy is crucial.
Purpose of the Study:
- To analyze the natural decrease in blood pressure for nonemergent hypertension in the ED.
- To determine if immediate pharmacological intervention is always necessary.
Main Methods:
- Retrospective review of 94 hypertension cases at University of Illinois Hospital.
- Analysis of triage blood pressure and a second reading within 2 hours, before treatment.
- Exclusion of patients with diastolic pressure < 90 mm Hg or acute end-organ pathology.
Main Results:
- A significant mean arterial pressure decrease of 6% (P < .003).
- Significant systolic (6%, P < .022) and diastolic (6.4%, P < .003) pressure reductions observed.
- Greater blood pressure decrease noted in patients with initial diastolic pressure ≥ 115 mm Hg.
Conclusions:
- Nonemergent hypertension often shows a natural blood pressure decline in the ED.
- Immediate pharmacological intervention may not be required for all nonemergent hypertension cases.
- Observation and reassessment prior to treatment are recommended.
Abstract:
In order to characterize the decrease in blood pressure that occurs in the emergency department (ED) setting in cases of nonemergent hypertension before beginning pharmacological therapy, 94 consecutive cases of hypertension seen at the University of Illinois Hospital were reviewed. Each patient in the analysis had a triage blood pressure recorded by the nursing staff and second blood pressure reading taken between 10 minutes and 2 hours after the triage pressure before pharmacological therapy was begun. Patients with diastolic pressures less than 90 mm Hg were excluded, as were patients with acute end-organ pathology secondary to hypertension. In the remaining 54 cases, the mean arterial pressure fell by 6% (P less than .003), the systolic pressure fell by 6% (P less than .022), and the diastolic pressure fell by 6.4% (P less than .003), suggesting that in nonemergent hypertension, a significant decrease in blood pressure occurs in the ED before pharmacological therapy is begun. The blood pressure decrease was not statistically different when sex and age were considered, but when patients were grouped into those with diastolic pressures between 90 mm Hg and 114 mm Hg and those with diastolic pressures greater than or equal to 115 mm Hg, there was a statistically significant decrease in systolic, diastolic, and mean arterial pressures only in patients with diastolic pressures greater than or equal to 115 mm Hg. Our findings suggest that patients with nonemergent hypertension do not always require immediate and aggressive pharmacological intervention in the ED setting and are best observed for a short period and then reassessed before beginning pharmacological therapy.