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Asymptomatic hypertension in the ED

W K Chiang1, B Jamshahi

  • 1Emergency Medical Services, Bellevue Hospital Center, New York, NY 10016, USA.

The American Journal of Emergency Medicine
|November 25, 1998
PubMed
Summary

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.

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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.

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