Analysis of short term clinical follow up of hypertensive patients in the emergency department

Abstract

Introduction: The objective of this study is to delineate demographic and clinical characteristics of patients found to have high blood pressure (BP) values in the emergency department (ED) and eventually diagnosed with hypertensive urgency (HU) and hypertensive emergency (HE). The second aim is to investigate and analyze one-month follow-up data regarding the cases with HU.
Material and Method: This prospective clinical observational study was conducted in a University-based ED in three months period. All consecutive adult patients with a BP level above 140/90 mmHg with a proper technique were recruited for the study. Data sheets were filled in by emergency physicians on duty. Patients with diastolic BP higher than 115 mmHg without any documented end-organ damage were assigned to HU group. Findings in urinalysis, renal function tests, ECG and chest X-rays were noted and analyzed. Patients in HU group were contacted at the end of one month and interrogated if their symptoms had been persisting and if they had come to the hospital for follow-up.
Results: High BP levels in at least two separate measurements were documented in 276 patients in the three-month study period. Among these, 46 (16.6%) were classified as HE, 77 (27.8%) HU, and 153 (55.4%) as simple transient high BP. Mean age in HE and HU groups were 68.8±13.8 and 58.8±12.6, respectively. Patients in HE group were observed in the ED for longer periods when compared to HU group. Headache was the most common symptom (n=21, 27.3%) in patients with HU, while chest pain (n=12, %26.1) and shortness of breath (n=12, %26.1) were the two most common complaints in the HE group. Systolic BP values were similar in the two groups, whereas mean diastolic BP in HU group was found to be higher than HE group (p=0.014). Thirty-four patients (44.1%) in HU group had revisited thehospital for follow-up examination after one week. In this group, 19 (24.7%) patients reported at least one complaint in one-month follow- up phone inquiry.
Conclusion: A myriad of different complaints can be reported by patients admitted to the ED and found to have high BP, with headache being the most common. Emergency physicians need to have a high index of suspicion for end-organ damage in these patients, and have a low threshold to employ adjunctive tests to complete necessary workup and examination. Most patients can be managed in an outpatient basis in the ED with simple interventions, drug therapy, close follow-up and be discharged from the ED. Patients in HU group without any end-organ damage can be safely discharged with oral treatment and follow-up recommendations.