Hypertension Management in Emergency Departments

Author:

Miller Joseph12,McNaughton Candace3,Joyce Katherine12,Binz Sophia12,Levy Phillip2ORCID

Affiliation:

1. Henry Ford Hospital, Detroit, Michigan, USA

2. Wayne State University, Detroit, Michigan, USA

3. Vanderbilt University Medical Center and Tennessee Valley Healthcare System VA, Nashville, Tennessee, USA

Abstract

Abstract BACKGROUND Elevated blood pressure (BP) is pervasive among patients that visit emergency departments (EDs) for their care. METHODS In this review article, we outline the current approach to the management of these individuals and highlight the crucial role emergency medicine clinicians play in reducing the morbidity associated with elevated BP. RESULTS We highlight the critical importance of immediate treatment when elevated BP contributes to new or worsening end-organ injury but emphasize that such hypertensive emergencies are rare. For the vast majority of patients with elevated BP in the ED who do not have new or worsening end-organ injury from elevated BP, immediate BP reduction within the ED is not recommended or safe. Nonetheless, within weeks after an ED visit, there is a pressing need to improve the care of patients with elevated or previously undiagnosed hypertension. For many, it may be their only regular point of engagement with the healthcare system. To address this, we present novel perspectives that envision a new role for emergency medicine in chronic hypertension management—one that acknowledges the significant population-level gaps in BP control that contribute to disparities in cardiovascular disease and sets the stage for future changes in systems-based practice. CONCLUSIONS Emergency medicine plays a key and evolving role in reducing morbidity associated with elevated BP.

Publisher

Oxford University Press (OUP)

Subject

Internal Medicine

Reference68 articles.

1. Heart disease and stroke statistics—2018 update: a report from the American Heart Association;Benjamin;Circulation,2018

2. Hypertension prevalence and control among adults: United States, 2015–2016;Fryar;NCHS Data Brief,2017

3. Vital signs: prevalence, treatment, and control of hypertension—United States, 1999–2002 and 2005–2008;Center for Disease Control and Prevention;MMWR,2011

4. Blood pressure measurements at emergency department visits by adults: United States, 2007–2008;Niska;NCHS Data Brief,2011

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