Study: High Blood Pressure Readings Are Not Always an Emergency
Over the past decade, visits to the emergency department (ED) made primarily for hypertension have increased significantly despite decreases in rates of subsequent mortality and hospitalization, according to a recent study.
While visits to the ED for hypertension alone are common, the outcomes of these patients are not well documented.
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To better assess these outcomes, the researchers conducted a retrospective cohort study using data from health databases in the province of Ontario, Canada, recorded between April 1, 2002 and March 31, 2012. All patients had a primary diagnosis of hypertension. The researchers assessed mortality outcomes and hypertensive complications at 7, 30, 90, and 365 days and at 2 years following ED visit.
Overall, 206,147 visits were included in the analysis. Visits increased by 64% between 2002 and 2012, while rates of hospitalization following ED visit decreased from 9.9% to 7.1% during the study period. Mortality rates were less than 1% at 90 days, 2.5% within 1 year, and 4.1% within 2 years.
Stroke was the most common admitting diagnosis among subsequent hospitalizations for hypertensive complications, but only had a frequency of less than 1% at 1 year. Overall, hospitalization for stroke, heart failure, acute myocardial infarction, atrial fibrillation, renal failure, hypertensive encephalopathy, and dissection were less than 1% at 30 days.
The researchers noted that the increases in ED visits for hypertension may be due in part to an aging population, but may also be due to increased emphasis on home blood pressure monitoring.
"We encourage patients to monitor their blood pressure at home if they have been diagnosed with hypertension, but not every high blood pressure reading is an emergency," the researchers concluded.
"Stroke remains a huge killer and we do appreciate patients with hypertension being so conscientious about monitoring their readings," they said. "Patients should be aware that unless their high blood pressure coincides with symptoms of a medical emergency, such as chest pain, severe headache, nausea or shortness of breath, they probably do not need to visit the ER. We of course encourage them to follow up as soon as possible with their regular physician. If there is any doubt, come to the emergency department: we would rather have you come without an emergency than stay home with one."
—Michael Potts
References:
High blood pressure by itself is not necessarily an emergency [press release]. Washington, DC: American College of Emergency Physicians; July 7, 2016. http://newsroom.acep.org/2016-07-07-High-Blood-Pressure-By-Itself-Is-Not-Necessarily-An-Emergency. Accessed July 8, 2016.
Masood S, Austin PC, Atzema CL. A population-based analysis of outcomes in patients with a primary diagnosis of hypertension in the emergency department [published online July 6, 2016]. Ann Emerg Med. doi: http://dx.doi.org/10.1016/j.annemergmed.2016.04.060.