Comparison of Outcomes After Treatment of Asymptomatic Hypertension in the Emergency Department in Admitted Patients

Document Type

Conference Proceeding

Publication Date

10-2023

Publication Title

Annals of Emergency Medicine

Abstract

Objectives: Hypertension, or elevated blood pressure (BP), is very prevalent in the United States with 45.4% of adults being affected and is a well- established risk factor for heart disease, kidney disease, and stroke. It is a common complaint in emergency departments (EDs), and hypertension-related hospitalizations have been growing over the years, with a 27% increase from 2000 to 2011. Current ED guidelines do not recommend treating asymptomatic hypertension in the ED for discharged patients. Studies have been done that show there are no significant benefits to starting antihypertensive treatment on these patients in the ED. However, little is known about outcomes in admitted patients who receive treatment for asymptomatic hypertension. Therefore, we hypothesized that administration of antihypertensive medication in the ED for admitted asymptomatic hypertensive patients improves outcomes, by reducing ICU admissions, Rapid Response Team calls, deaths, and adverse events. Methods: We conducted a retrospective chart review study of patients presenting to a Corewell Health East (formerly Beaumont Health) ED from 2015-2022 who were admitted to an inpatient or observational unit with at least one BP reading of >160/100 in the ED. We compared patients who received IV or oral antihypertensive medications with those who did not. We also compared results in patients that were taking antihypertensive medications prior to the ED visit and those that were not. Logistic regression was used to assess the effects of ED antihypertensive medication after adjusting for age, sex, race, BMI, hypertension stage, and Elixhauser comorbidity index. Odds ratios (OR) were reported with 95% confidence interval (CI) and p-value. Results: We found that in all patients who received antihypertensive treatment, the number of ICU admissions was significantly reduced, regardless of antihypertensive use prior to ED visit (OR 0.800, 95% CI 0.720-0.900, p<0.001). There were no changes in rate of death or Rapid Response Team calls. However, in patients not previously prescribed antihypertensives, treating hypertension with medications in the ED was associated with a significantly increased rate of ischemic strokes (OR 3.530, 95% CI 1.420-8.720, p¼0.01). Conclusions: ED treatment of elevated BP is associated with a decrease in ICU admissions, particularly in patients being treated with antihypertensive medications outpatient. However, there is risk associated, as demonstrated by the increased risk of ischemic strokes in treated patients. This study highlights the importance of using caution when treating asymptomatic hypertensive patients in the ED, especially in patients not taking antihypertensive medications outpatient. No, authors do not have interests to disclose

Volume

82

Issue

4 Suppl.

First Page

S141

Comments

American College of Emergency Physicians ACEP Research Forum, October 9-12, 2023, Philadelphia, PA

DOI

10.1016/j.annemergmed.2023.08.349

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