Initiation of Therapy for Asymptomatic Hypertension in the Emergency Department
UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.Annals of emergency medicine (Impact Factor: 4.68). 12/2009; 54(6):791-2. DOI: 10.1016/j.annemergmed.2009.05.001
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ABSTRACT: This review updates concepts of hypertension evaluation and management in patients presenting to the emergency department. It outlines the current challenges faced by emergency physicians in the identification and management of hypertensive patients: In spite of published emergency care guidelines, identification and referral rates remain low in patients presenting to the emergency department with moderate blood pressure (BP) elevations. In patients with severely elevated BP, the evaluation for acute end organ damage remains inconsistent and is symptom-based. Using current consensus guidelines, this review provides an algorithm for the management of the hypertensive emergency department patient. The final section of this review outlines management strategies for specific hypertensive emergencies.Journal of the American Society of Hypertension 06/2011; 5(5):366-77. DOI:10.1016/j.jash.2011.05.002 · 2.61 Impact Factor
Article: Hypertensive crisisJournal of Hypertension 05/2012; 30(5):882-3. DOI:10.1097/HJH.0b013e328352ea35 · 4.72 Impact Factor
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ABSTRACT: The objective is of the study to evaluate the effect of antihypertensive therapy in emergency department (ED) patients with markedly elevated blood pressure (BP) but no signs/symptoms of acute target organ damage (TOD). This is a retrospective cohort study of ED patients age 18 years and older with an initial BP greater than or equal to 180/100 mm Hg and no acute TOD, who were discharged with a primary diagnosis of hypertension. Patients were divided based on receipt of antihypertensive therapy and outcomes (ED revisits and mortality) and were compared. Of 1016 patients, 435 (42.8%) received antihypertensive therapy, primarily (88.5%) oral clonidine. Average age was 49.2 years, and 94.5% were African American. Treated patients more often had a history of hypertension (93.1% vs 84.3%; difference = -8.8; 95% confidence interval [CI], -12.5 to -4.9) and had higher mean initial systolic (202 vs 185 mm Hg; difference = 16.9; 95% CI, -19.7 to -14.1) and diastolic (115 vs 106 mm Hg; difference = -8.6; 95% CI, -10.3 to -6.9) BP. Emergency department revisits at 24 hours (4.4% vs 2.4%; difference = -2.0; 95% CI, -4.5 to 0.3) and 30 days (18.9% vs 15.2%; difference = -3.7; 95% CI, -8.5 to 0.9) and mortality at 30 days (0.2% vs 0.2%; difference = 0; 95% CI, -1.1 to 0.8) and 1 year (2.1% vs 1.6%; difference = -0.5; 95% CI, -2.5 to 1.2) were similar. Revisits and mortality were similar for ED patients with markedly elevated BP but no acute TOD, whether they were treated with antihypertensive therapy, suggesting relative safety with either approach. Copyright © 2015. Published by Elsevier Inc.The American journal of emergency medicine 05/2015; 33(9). DOI:10.1016/j.ajem.2015.05.036 · 1.27 Impact Factor
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