Abstract FR570: They Told Me My Numbers Were High - Emergency Department Management of Asymptomatic Hypertension Based on Referral Status

Current guidelines recommend against sending asymptomatic hypertension (aHTN) to the emergency department, nevertheless these patients still present to the ED, whether due to their own concern or referred there by a physician. While the American College of Emergency Physicians recommends minimal workup, some patients end up with much more elaborate testing. We conducted a retrospective chart review of patients with asymptomatic hypertension presenting to a Mount Sinai Hospital ED to identify any variation in management between self-referred patients and those sent in by a provider, and to characterize their diagnostic and treatment journeys in the ED. Statistical analysis was conducted using SAS, and significance was determined with a p value <0.05; t-tests were used for continuous data and chi-squared or Fisher’s exact for categorical. Adult patients with at least stage 1 hypertension were included. Patients who were pregnant or peri-partum, or presenting for trauma were excluded. 474 patients were identified over a 3-month period, of whom 117 (24.68%) were sent to the ED by another provider. The groups did not differ significantly by gender, race-ethnicity, or age. The most common referring specialties were primary care (35%), urgent care (17%), and combined surgical specialties (10%). The referred patients had significantly higher presenting systolic (mean 192 vs 172, p<0.0001) and diastolic (mean 103 vs 93, p<0.0001) blood pressures than those who self-referred. They were more likely to be admitted (4% vs 1.64%) and to leave against medical advice (3% vs 1.40%), though the differences were not statistically significant. Similarly, there was no statistical difference in how many patients received ECGs (60% vs 54%) or had at least one imaging study ordered (19% vs 20%) or appropriate blood testing ordered (52% vs 55%). Patients were more likely to receive antihypertensive medication if they were referred (48% vs 24%, p<0.001), and more likely to receive an IV antihypertensive medication (9% vs 3%, p=0.0015). In a linear regression model, the only significant predictor of provision of standard of care was presenting blood pressure. Although official guidelines agree that emergency management of aHTN is unnecessary, these patients can still present to the ED. Our findings show significant variation in management for patients sent in by other providers, as well as a surprising difference in overall management from the minimalistic recommendations.