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

Abstract

BackgroundAlthough 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. ObjectivesThis study aims to investigate the effect of predischarge BP on short-term follow-up results for ED patients with ASH. MethodsThe prospective observational study was performed in the ED of a tertiary care hospital during a 3-month period. Adult patients who had systolic BP ≥180mm Hg and diastolic BP ≥100mm 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 1week and identified their related adverse events. ResultsOne 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. ConclusionPredischarge 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.