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Blood Pressure Spikes Don't Always Need Emergency Room Care

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A sudden spike in blood pressure is not an indication to bring the patient to the emergency room, a new study has revealed.

In the study by researchers in Cleveland Clinic, they have found that only 1 percent of the 60,000 patients needed emergency intervention by doctors. Majority of the patients had good outcome despite receiving the necessary treatment before being sent home.

Hypertensive urgency is described as having a spike in blood pressure of 180/110 millimeters of mercury (mmHg). Many of the patients and their relatives find the blood pressure alarming — a reading that may need hospital admission or emergency care treatment, particularly for those who have history of hypertension.

Lead researcher Krishna Patel said it would do the patient no harm if they will only be treated as an outpatient "because cardiovascular complications are rare in the short term."

Those who have elevated blood pressure without any signs or symptoms of severe organ damage can be safely managed as an outpatient and sent home.

Admittedly, the researchers said that elevated blood pressure results in organ failure over time, but it does not necessarily mean that sending them to the ER would be the best management for the cases. In their research, they found that only 0.7 percent of patients would benefit from ER care. Patients sent to the ER have the same patient outcomes with those who were sent home.

In fact, patients who have had hypertensive urgency and were sent home had lower hospital admission rates over the coming weeks from the initial elevation. Outpatient management is more cost-effective than ER care.

The researchers argued that the only advantage of sending the patient to ER would be the increase in utilization of medical care and not improved patient outcomes. However, the patients were noted to still have uncontrolled elevation of blood pressure several months from the episode of hypertensive urgency.

Lenox Hill Hospital Women's Heart Health Director Suzanne Steinbaum said that while study findings are reassuring, it is also alarming that the hypertension of the patients remain uncontrolled. Steinbaum believes that shifting the focus on controlling blood pressure should be the main thrust of health practitioners.

Family Medicine chair Howard Selinger of Frank H. Netter M.D. School of Medicine said that treatment of patients with hypertensive urgency should depend on the clinical manifestation. He added that doctors must factor in frailty, in addition to the availability of outpatient treatment and speed of communication.

"If this patient is a frail elderly who perhaps sustained an earlier stroke, that changes the potential for an adverse outcome," said Selinger. More importantly, doctors must be quick to recognize hypertensive crisis from hypertensive urgency.

The study is published online in JAMA Internal Medicine on June 13.

Photo: Bernard Goldbach | Flickr

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