Hypertensive Urgency—Is This a Useful Diagnosis?

Heath, Iona

doi:10.1001/jamainternmed.2016.1498

Cited by 11 publications

(5 citation statements)

References 8 publications

(4 reference statements)

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“…The majority of patients did not require any antihypertensives (even with higher-than-average blood pressure) throughout their stay in the ED, and most were sent home without any outpatient prescriptions. This supports that: 1) these cases could be managed in the community; and 2) these ED visits do not significantly benefit the patients and mirror a recent study where only 0.7% of patients required ongoing care and/or referral [ 9 ]. Finally, the ED feedback by emergency physicians was found to be inconsistent, with a minority of patients having an after-visit summary sent to the family doctor (the majority of patients in both groups had a family doctor) explaining their course through the ED.…”

Section: Discussionsupporting

confidence: 80%

Review of Referrals Sent to the Emergency Department for Management of Hypertension

Richard

Chomienne

2021

Cardiol Res

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Background: Hypertensive urgencies, unlike hypertensive emergencies, are severe episodes of hypertension without evidence of end-organ damage. Most recent guidelines advise against referring patients with hypertensive urgencies to the emergency department (ED) for treatment. There is a lack of Canadian data surrounding whether referrals to the ED regarding hypertension are appropriate. We analyzed referrals to the Montfort Hospital ED due to hypertension and assessed if they met the criteria for hypertensive emergencies.Methods: This was a retrospective chart study of all ED visits at Montfort Hospital from the 2016 fiscal year with a final diagnosis/chief complaint of hypertension. Charts were assessed to determine if these patients met the criteria for having true hypertensive emergencies.Results: Out of the 54,000 visits to the Montfort ED, 254 reported hypertension as a final diagnosis/chief complaint. Of those, 67 patients had been referred by a healthcare practitioner, while 187 were self-referred. None of the referred patients met the criteria for hypertensive emergency; however, eight of these patients did have symptoms indicating a possibility of hypertensive emergency. Six of the self-referred patients met criteria for hypertensive emergency. The majority (71.6%) of patients referred did not require on-site antihypertensive treatment, and 37.3% of patients were sent home with new outpatient prescriptions. Conclusion:All the cases referred to the Montfort ED for hypertension were considered hypertensive urgencies and none of them required ED hypertensive treatment. Further investigation is required to help optimize appropriate patient referral to the ED for true hypertensive emergencies and improve management of hypertensive urgencies in the community.

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Section: Discussionsupporting

confidence: 80%

Review of Referrals Sent to the Emergency Department for Management of Hypertension

Richard

Chomienne

2021

Cardiol Res

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“…The goal of this investigation is to characterize the incidence of hypertensive emergency in EDs nationwide in the period from 2006 through 2013. 20 Thus, all visits that culminated in discharge from the ED were excluded as such a disposition is inconsistent with presence of a true hypertensive emergency, regardless of ICD-9 coding. Acute target organ damage was defined by additional coding for any one of the following:…”

Section: Goals Of This Investigationmentioning

confidence: 99%

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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“…De las 60 tomografías computadas solicitadas, ninguna fue anormal. Esto refleja un gasto in-necesario, exposición a radiación y potenciales daños para nuestros pacientes 2 . Un último dato a remarcar es que a los seis meses de seguimiento más del 60% de los pacientes presentaron hipertensión arterial no controlada independientemente del grupo al que pertenecían (hospital vs hogar).…”

Section: Resultados Obtenidosunclassified

El manejo de la urgencia hipertensiva en la central de emergencias no reduce la incidencia de eventos cardiovasculares

Esposito¹

2018

Evid actual pract ambul

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Hypertensive Urgency—Is This a Useful Diagnosis?

Cited by 11 publications

References 8 publications

Review of Referrals Sent to the Emergency Department for Management of Hypertension

Review of Referrals Sent to the Emergency Department for Management of Hypertension

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

El manejo de la urgencia hipertensiva en la central de emergencias no reduce la incidencia de eventos cardiovasculares

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