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Am J Emerg Med. 2015 Sep;33(9):1219-24. doi: 10.1016/j.ajem.2015.05.036. Epub 2015 May 30.

Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort.

Author information

1
Department of Emergency Medicine, Wayne State University, Detroit, MI; Cardiovascular Research Institute, Wayne State University, Detroit, MI. Electronic address: plevy@med.wayne.edu.
2
Internal Medicine, St Joseph Mercy Ann Arbor, Ann Arbor, MI.
3
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI.
4
Department of Emergency Medicine, Akron General Medical Center, Akron, OH.
5
Department of Emergency Medicine, Wayne State University, Detroit, MI.
6
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
7
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI.
8
Michigan State University College of Osteopathic Medicine, East Lansing, MI.
9
Department of Emergency Medicine, Wayne State University, Detroit, MI; Wayne State University School of Medicine, Detroit, MI; Department of Emergency Medicine, University of Illinois Medical Center, Chicago, IL.
10
Department of Emergency Medicine, Wayne State University, Detroit, MI; Internal Medicine, St Joseph Mercy Ann Arbor, Ann Arbor, MI.
11
Cardiovascular Research Institute, Wayne State University, Detroit, MI; Department of Internal Medicine, Wayne State University, Detroit, MI.

Abstract

OBJECTIVES:

The objective is of the study to evaluate the effect of antihypertensive therapy in emergency department (ED) patients with markedly elevated blood pressure (BP) but no signs/symptoms of acute target organ damage (TOD).

METHODS:

This is a retrospective cohort study of ED patients age 18 years and older with an initial BP greater than or equal to 180/100 mm Hg and no acute TOD, who were discharged with a primary diagnosis of hypertension. Patients were divided based on receipt of antihypertensive therapy and outcomes (ED revisits and mortality) and were compared.

RESULTS:

Of 1016 patients, 435 (42.8%) received antihypertensive therapy, primarily (88.5%) oral clonidine. Average age was 49.2 years, and 94.5% were African American. Treated patients more often had a history of hypertension (93.1% vs 84.3%; difference = -8.8; 95% confidence interval [CI], -12.5 to -4.9) and had higher mean initial systolic (202 vs 185 mm Hg; difference = 16.9; 95% CI, -19.7 to -14.1) and diastolic (115 vs 106 mm Hg; difference = -8.6; 95% CI, -10.3 to -6.9) BP. Emergency department revisits at 24 hours (4.4% vs 2.4%; difference = -2.0; 95% CI, -4.5 to 0.3) and 30 days (18.9% vs 15.2%; difference = -3.7; 95% CI, -8.5 to 0.9) and mortality at 30 days (0.2% vs 0.2%; difference = 0; 95% CI, -1.1 to 0.8) and 1 year (2.1% vs 1.6%; difference = -0.5; 95% CI, -2.5 to 1.2) were similar.

CONCLUSIONS:

Revisits and mortality were similar for ED patients with markedly elevated BP but no acute TOD, whether they were treated with antihypertensive therapy, suggesting relative safety with either approach.

PMID:
26087706
DOI:
10.1016/j.ajem.2015.05.036
[Indexed for MEDLINE]

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