Epidemiology of elevated blood pressure in the ED

Adhikari, Srikar; Mathiasen, Ross

doi:10.1016/j.ajem.2014.08.034

Cited by 10 publications

(4 citation statements)

References 14 publications

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“…Thus, while markedly elevated BP at presentation to the ED is quite common, 21,22 occurring in nearly 20% of patients, 23 the likelihood that it represents a true hypertensive emergency may be lower than previously thought. 12 By definition, true hypertensive emergencies are an indication for rapid BP lowering.…”

Section: Discussionmentioning

confidence: 95%

“…Our primary finding is that ED visits for hypertensive emergency, that is, ED visits for patients who have markedly elevated BP with acute target organ damage and an acuity level high enough to necessitate hospital admission, are quite rare, accounting for less than 2 in 1000 adult ED visits and 6 in 1000 visits carrying any diagnosis of hypertension in 2013. Thus, while markedly elevated BP at presentation to the ED is quite common, occurring in nearly 20% of patients, the likelihood that it represents a true hypertensive emergency may be lower than previously thought …”

Section: Discussionmentioning

confidence: 96%

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Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Janke

McNaughton

Brody

et al. 2016

JAHA

104

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BackgroundThe incidence of hypertensive emergency in US emergency departments (ED) is not well established.Methods and ResultsThis study is a descriptive epidemiological analysis of nationally representative ED visit‐level data from the Nationwide Emergency Department Sample for 2006–2013. Nationwide Emergency Department Sample is a publicly available database maintained by the Healthcare Cost and Utilization Project. An ED visit was considered to be a hypertensive emergency if it met all the following criteria: diagnosis of acute hypertension, at least 1 diagnosis indicating acute target organ damage, and qualifying disposition (admission to the hospital, death, or transfer to another facility). The incidence of adult ED visits for acute hypertension increased monotonically in the period from 2006 through 2013, from 170 340 (1820 per million adult ED visits overall) to 496 894 (4610 per million). Hypertensive emergency was rare overall, accounting for 63 406 visits (677 per million adult ED visits overall) in 2006 to 176 769 visits (1670 per million) in 2013. Among adult ED visits that had any diagnosis of hypertension, hypertensive emergency accounted for 3309 per million in 2006 and 6178 per million in 2013.ConclusionsThe estimated number of visits for hypertensive emergency and the rate per million adult ED visits has more than doubled from 2006 to 2013. However, hypertensive emergencies are rare overall, occurring in about 2 in 1000 adult ED visits overall, and 6 in 1000 adult ED visits carrying any diagnosis of hypertension in 2013. This figure is far lower than what has been sometimes cited in previous literature.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 96%

Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Janke

McNaughton

Brody

et al. 2016

JAHA

104

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“…In the United States, although 18% of ED patients have severely elevated blood pressure at or above 180/110 mmHg upon presentation, 3 far fewer have hypertensive emergency, as previously defined, which occurs in conjunction with acute or impending target organ damage. From 2006 through 2013, the estimated number of visits for hypertensive emergency more than doubled, but true hypertensive emergency accounted for only 0.2% of adult ED patients overall and 0.6% of adult ED patients with a diagnosis of hypertension.…”

Section: The Prevalence Of Hypertensive Crisesmentioning

confidence: 90%

CE: Hypertensive Emergencies: A Review

Sharma

Mathews

Newton

2021

AJN, American Journal of Nursing

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While acute blood pressure elevations are commonly seen in the ED, not all require emergency treatment. True hypertensive emergencies are characterized by a rapid elevation in blood pressure to a level above 180/120 mmHg and are associated with acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy. Recognizing the clinical signs and symptoms of hypertensive emergency, which may vary widely depending on the target organ involved, is critical. High blood pressure levels that produce no signs or symptoms of target organ damage may be treated without hospitalization through an increase in or reestablishment of previously prescribed oral antihypertensive medication. However, all patients presenting with blood pressure this high should undergo evaluation to confirm or rule out impending target organ damage, which differentiates hypertensive emergency from other hypertensive crises and is vital in facilitating appropriate emergency treatment. Drug therapy for hypertensive emergency is influenced by end-organ involvement, pharmacokinetics, potential adverse drug effects, and patient comorbidities. Frequent nursing intervention and close monitoring are crucial to recuperation. Here, the authors define the spectrum of uncontrolled hypertension; discuss the importance of distinguishing hypertensive emergencies from hypertensive urgencies; and describe the pathophysiology, clinical manifestations, and management of hypertensive emergencies.

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“…HTN-C represents a large portion of total emergency department (ED) evaluations, with one study finding 9% of patients seen at a large academic hospital over a 1 year period had a BP of more than 180/110 mmHg on presentation [3]. HTN-E is less common, with past studies reporting 0.2-0.8% of total ED evaluations [4,5].…”

Section: Epidemiologymentioning

confidence: 99%

Hypertensive crisis: diagnosis, presentation, and treatment

Stewart¹

2023

Current Opinion in Cardiology

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Purpose of reviewHypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.Recent findingsNovel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130–140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.SummaryHTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.

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Epidemiology of elevated blood pressure in the ED

Cited by 10 publications

References 14 publications

Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013

CE: Hypertensive Emergencies: A Review

Hypertensive crisis: diagnosis, presentation, and treatment

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