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Objective: Background: Elevated blood pressure (BP) is a frequent cause of admittance to the Emergency Department (ED). Since this group of patients is characterized by great heterogeneity, considerable efforts were put to stratify them according to medical state severity and corresponding prognosis. Little is known about this cohort of patients, which in light of their substantial volume burden pose a significant challenge for physicians at the EDs Aim: To characterize patients admitted to an ED for elevated BP and to evaluate factors associated with hospitalization. Design and method: Methods: This retrospective analysis comprised all patients (N=578) admitted to an ED of the university hospital in 2022 due to acute BP rise with an exclusion of hypertensive emergencies. Results: The studied group constituted 1.5% of all ED visits in 2022. The median age was 67 years; 69% were females. Headache, and vertigo (36.3%), chest pain (26.8%) as well as shortness of breath (11.4%), and neurological deficits (10.9%) were the most common complaints, however every fifth patient was asymptomatic (22.8%). Median SBP (200 mmHg, n=346) and diastolic BPs (DBP) (105 mmHg, n=316) measured at home were significantly higher than median SBP (173 mmHg n=578) and DBP (95 mmHg, n=578) during triage (p<0.0001). BP-lowering agents prior to admission to ED was taken by 38.6% of patients. In vast majority of patient captopril was used as prehospital BP lowering agent (91%). In the ED nitrendipine was administrated 53.5% of admitted patients, captopril was being administered often (37.5%), whereas furosemide (16.1%), urapidil (9.9%), and nitroglycerine (1.9%) were used less likely. Eventually, a median SBP/DBP of 140/82 mmHg was reached in the median of 289 minutes spent at the ED, i.e. approximately 5 hours. Hospitalization was necessary in 5.4% of patients, whereas 40% of them underwent antihypertensive treatment adjustment. Multivariable regression revealed that median arterial pressure (MAP) was not associated with hospitalization, however, furosemide (odds ratio (OR), 2.2, p<0.01) or urapidil administration (OR, 1.999, p<0.01) increased such risk. Conclusions: Improvements in pre-ED management and long-term hypertension treatment may reduce patients seeking ED for elevated BP without end-organ damage.
Nowicki et al. (Wed,) studied this question.