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Am J Emerg Med. 2016 May;34(5):834-9. doi: 10.1016/j.ajem.2016.01.013. Epub 2016 Jan 21.

Effect of predischarge blood pressure on follow-up outcomes in patients with severe hypertension in the ED.

Author information

1
Emergency Medicine Unit, Outpatient Department, King Chulalongkorn, Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand. Electronic address: quest_p_n@hotmail.com.
2
Emergency Medicine Unit, Outpatient Department, King Chulalongkorn, Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand; Emergency Medicine Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand. Electronic address: khrongwong.m@chulahospital.org.
3
Emergency Medicine Unit, Outpatient Department, King Chulalongkorn, Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand. Electronic address: d.nadol@gmail.com.
4
Emergency Medicine Unit, Outpatient Department, King Chulalongkorn, Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand. Electronic address: khuansiri9@gmail.com.
5
Emergency Medicine Unit, Outpatient Department, King Chulalongkorn, Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand. Electronic address: patiputt@gmail.com.
6
Emergency Medicine Unit, Outpatient Department, King Chulalongkorn, Memorial Hospital, the Thai Red Cross Society, 1873, Rama 4 Rd, Patumwan, Patumwan, Bangkok 10330, Thailand. Electronic address: lltongtaa@gmail.com.

Abstract

BACKGROUND:

Although emergency department (ED) patients with asymptomatic severe hypertension (ASH) generally have no serious short-term hypertension-related adverse events, it is unclear whether persistently high discharge blood pressure (BP) affects the outcome due to the dynamic nature of BP.

OBJECTIVES:

This study aims to investigate the effect of predischarge BP on short-term follow-up results for ED patients with ASH.

METHODS:

The prospective observational study was performed in the ED of a tertiary care hospital during a 3-month period. Adult patients who had systolic BP ≥180 mm Hg and diastolic BP ≥100 mm Hg without acute end-organ damage were enrolled and treated at the emergency physicians' discretion. Discharge BP was precategorized into severely high and moderately high groups. We compared the groups using direct telephone contact and medical record reviews of follow-up BP within 1 week and identified their related adverse events.

RESULTS:

One hundred and forty-six eligible cases were identified in this study; 1 patient (0.7%) had a serious hypertension-related adverse event. One hundred and thirteen patients had follow-up BP information available. There was no difference in mean systolic BP and diastolic BP at follow-up between patients who were discharged from the ED with severely high vs moderately high BP.

CONCLUSION:

Predischarge BP value is not associated with immediate serious adverse events and does not affect short-term BP control in ED patients with ASH. Further study on the need to lower BP during the ED stay and on antihypertensive prescriptions for these patients is required.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02534324.

PMID:
26874395
DOI:
10.1016/j.ajem.2016.01.013
[Indexed for MEDLINE]

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