Blood pressure decrease prior to initiating pharmacological therapy in nonemergent hypertension

Lebby, Tom; Paloucek, Frank; Cruz, Francine Dela; Leikin, Jerrold B.

doi:10.1016/0735-6757(90)90289-c

Cited by 14 publications

(5 citation statements)

References 11 publications

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“…Although many patients with severe, uncomplicated hypertension are diagnosed and treated as hypertensive urgencies, most cases of uncomplicated hypertension may not require immediate control of the blood pressure. 1,[16][17][18][19][20][21] It has been suggested that acute lowering of the blood pressure may actually be detrimental. 1,[17][18]22 On the other hand, the adverse effects of inadequate long-term therapy (months) of severe hypertension on the development of target organ effects are well documented.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation and management of patients with uncontrolled, severe hypertension: results from a public teaching hospital

et al. 1999

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ContextPatients: Ninety-one of 2898 consecutive visits to a public teaching hospital emergency department were specifically for severe, uncomplicated hypertension. Results: Of 2898 consecutive medical emergency department visits, there were 142 (4.9%) patient visits specifically for systolic blood pressure (SBP) у220 mm Hg or diastolic blood pressure (DBP) у120 mm Hg. Ninety-one of the 142 patient visits were for severe hypertension in the absence of acute target organ impact or neuroretinopathy. Eighty-nine patients received acute drug therapy. Twenty-nine patients received two drugs, and 15 received three drugs. Sixty-

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Section: Discussionmentioning

confidence: 99%

Clinical presentation and management of patients with uncontrolled, severe hypertension: results from a public teaching hospital

et al. 1999

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“…A common perception remains that HTN management and treatment should occur outside the ED. [3][4][5][6] However, most ED patients with an elevated initial BP will continue to have elevated BPs after discharge, regardless of the severity of the presenting condition, pain or anxiety. 7 ED visits for elevated BP are increasing 2 and rates of HTN awareness and control remain low in the United States 1 .…”

Section: Introductionmentioning

confidence: 99%

Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension

Goldberg

Wilson

Jambhekar

et al. 2019

High Blood Press Cardiovasc Prev

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Introduction-Emergency departments (EDs) are critical sites for hypertension (HTN) screening. Home blood pressure (BP) monitoring (HBPM) is used routinely in outpatient settings, yet its utility after the ED visit for those with elevated BP in the ED is unclear. In this pilot study, we assessed if HBPM could detect HTN in patients with elevated in-ED BP.Methods-From September 2014 to July 2017, we recruited adult patients at an urban, academic ED with a triage BP ≥ 120/80 mm Hg and no history of HTN into this prospective cohort observational study. After their ED visit, participants obtained BP measurements for two weeks using a validated HBPM. HTN was considered probable if the average HBPM BP was ≥ 135/85 mm Hg. We calculated the proportion of participants whose ED BP measurement accurately predicted HTN using HBPM after discharge.Results-Of 136 participants enrolled, 93 (68%) returned the HBPM with at least four home BP measurements (mean number of measurements obtained: 29 (SD: 17, range 4-59)). Participants' median age was 40 years-old (IQR 34-48); 55% were female, 19% were black, and 58% were white. Forty-six percent of participants with elevated in-ED BP had HTN in follow-up.Conclusion-For patients with elevated BP in the ED, HBPM could be valuable for determining which patients have HTN and require expedient follow-up.

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“…[14–17] Most patients with an elevated initial BP will continue to have abnormal BPs after discharge, despite the acuity of the presenting condition, pain or anxiety. [15, 30, 31, 27]…”

Section: Discussionmentioning

confidence: 99%

National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015

Goldberg

Marks

Merchant

2018

Journal of the American Society of Hypertension

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Background: Emergency department (ED)-based screening and referral of patients with elevated blood pressure (BP) is recommended by 2006 and 2013 American College of Emergency Physicians (ACEP) guidelines, however, it is unknown if these recommendations or disparities in care impact clinical practice. Objectives: (1) Assess temporal trends in antihypertensive prescriptions, outpatient follow-up referrals, and diagnosis of hypertension (HTN)/elevated BP and (2) identify potential disparities by patient characteristics. Methods: Using the 2005–2015 National Hospital Ambulatory Medical Care Survey, we examined the frequency and trends overtime of antihypertensive prescriptions, outpatient follow-up referrals, and BP diagnoses for US ED visits by adult patients with an elevated triage BP and identified potential disparities in management by patient demography and socioeconomic status. Results: Of the 594 million eligible ED visits by patients from 2005–2015, 1.2% (1.0 −1.4%) received antihypertensive prescriptions at discharge, 82.3% (80.0 – 83.6%) outpatient follow-up referrals, and 2.1% (1.9–2.4%) a HTN/elevated BP diagnosis. There were small annual increases over time in the odds of antihypertensive prescriptions at discharge (aOR 1.05 (1.00, 1.10)), follow-up referrals (aOR 1.04 (1.01, 1.07)), and HTN/elevated BP diagnosis (aOR 1.05 (1.02, 1.08)). For BPs ≥160/100 mm Hg, prescriptions were more common for Blacks (aOR 2.36 (1.93, 2.88)) and uninsured patients (aOR 1.81 (1.38, 2.38)), and diagnoses were more common for Blacks (aOR 1.95 (1.70, 2.24)) and uninsured patients (aOR 1.30 (1.09, 1.55)). Discussion: These data suggest little change in and the need for improvement in the management of ED patients with elevated BP, despite ACEP guidelines, and raise concern about patient care disparities.

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Blood pressure decrease prior to initiating pharmacological therapy in nonemergent hypertension

Cited by 14 publications

References 11 publications

Clinical presentation and management of patients with uncontrolled, severe hypertension: results from a public teaching hospital

Clinical presentation and management of patients with uncontrolled, severe hypertension: results from a public teaching hospital

Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension

National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015

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