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Asymptomatic hypertension in the ED
1Emergency Medical Services, Bellevue Hospital Center, New York, NY 10016, USA.
Insights
Asymptomatic hypertension is infrequent in the emergency department (ED). Physician treatment decisions for high blood pressure (BP) correlated with hypertension severity, though BP often normalized independently.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Research
Background:
- Asymptomatic hypertension is a common finding.
- Limited evidence supports emergency department (ED) treatment for asymptomatic hypertension.
- Physician management of elevated blood pressure (BP) in the ED is variable.
Purpose of the Study:
- To determine the frequency of asymptomatic hypertension in the ED.
- To analyze physician assessment and treatment patterns for asymptomatic hypertension.
- To evaluate blood pressure (BP) changes in patients with asymptomatic hypertension in the ED.
Main Methods:
- Retrospective chart review of 11,531 patients in an urban teaching hospital ED.
- Inclusion criteria: systolic BP ≥ 180 mm Hg or diastolic BP ≥ 110 mm Hg, excluding patients with organ dysfunction.
- Analysis of 269 patients meeting criteria, comparing treatment and non-treatment groups.
Main Results:
- 2.3% (269/11,531) of patients had asymptomatic hypertension.
- 20.8% (56/269) received antihypertensive treatment in the ED.
- Treatment group had higher initial BP (systolic, diastolic, MAP) and larger BP decrease in the ED compared to the non-treatment group.
Conclusions:
- Physician treatment decisions for asymptomatic hypertension in the ED correlated with the degree of BP elevation.
- Elevated BP readings in the ED tended to decrease over time, regardless of treatment.
- Further research is needed to establish optimal ED management strategies for asymptomatic hypertension.
Abstract:
A retrospective study in an urban, municipal, teaching hospital emergency department (ED) was conducted to evaluate (1) the frequency of asymptomatic hypertension in the ED, (2) the initial assessment and patterns of treatment by physicians, and (3) the changes in blood pressure (BP) in these patients. Patients with systolic BP > or = 180 mm Hg or diastolic BP > or = 110 mm Hg were included. Patients with cardiovascular, renal, or central nervous system dysfunction were excluded. Of the 11,531 charts reviewed, 269 (2.3%) met inclusion criteria. Of the 269 patients, 56 patients (20.8%) received antihypertensive treatment in the ED. The treatment group had a higher systolic BP (P < .001), diastolic BP (P < .001), and mean arterial blood pressure (MAP) (P < .001) than the nontreatment group. Fundoscopy was also performed more frequently in the treatment group (30.2% v 8.9%, P < .001). MAP decreased for both groups in the ED, but was higher in the treatment group (-20+/-21 v -11+/-21 mm Hg, P=.02). Despite the lack of support in the literature for the emergency treatment of asymptomatic hypertension in the ED, the individual physician's decision for treatment correlated with the degree of hypertension. Significantly elevated BP readings in the ED tended to decrease over time independent of any antihypertensive treatment, although the decrease was larger in the treated patients.