Can Diastolic Blood Pressure Decrease in Emergency Department Setting be Anticipated?

There are no obvious guidelines for therapy of elevated blood pressure (BP) in the emergency department (ED). Diastolic BP is probably more difficult to control compared with systolic BP.

To characterize patients who respond with a significant decrease in diastolic BP in the ED, whether treated or not.

In this retrospective cohort study, all patients attending a tertiary care ED with elevated BP were evaluated. Clinical characteristics of patients in whom diastolic BP decreased ≥20% were compared with those in whom diastolic BP decreased <20%.

Overall, 391 patients were included in the final analysis (64% females), of which diastolic BP of 106 (27%) patients decreased ≥20%. Patients in whom diastolic BP decreased ≥20% were older (70.1 ± 13 years vs. 65.9 ± 16.7 years, P = 0.011) and had a history of ischemic heart disease (IHD) and cerebrovascular disease (CVA) prior to the ED visit [30 patients (28.3%) vs. 45 patients (15.8%) for a history of IHD, P = 0.005 and 16 patients (15.1%) vs. 21 patients (7.4%) for CVA, P = 0.02].

A history of IHD is associated with a higher decrease in diastolic BP irrespective of the use of medical treatment during the ED visit whereas a history of TIA/CVA was associated with a higher decrease in diastolic BP only in patients who were treated in the ED.