High Blood Pressure Not Necessarily a Medical Emergency

Researchers at Sunnybrook Health Sciences Centre (Toronto, Canada), the University of Toronto (Canada), and other institutions conducted a retrospective cohort study based on linked health databases from the province of Ontario (Canada). They assessed 206,147 ED visits from 180 sites between 2002 and 2012, with a primary diagnosis of hypertension. The researchers then assessed mortality outcomes and potential hypertensive complications over a two-year period subsequent to the ED visit.

The results showed that ED emergency visits for hypertension increased from 15,793 to 25,950 (64%) over the study period, but conversely, the proportion of patients admitted to the hospital as a result decreased from 9.9% to 7.1%, a 28% reduction. Among patients who’s ED visit ended in admission to the hospital, the most frequent hospital diagnoses were stroke, renal failure, and heart failure. The proportion of patients arriving via ambulance also increased over time, from 10.7% to 14.3%.

The results also revealed that overall mortality was very low; less than one percent of patients died within 90 days, and only 4.1% died within two years. When taken together, hospitalization for heart failure, stroke, acute myocardial infarction (MI), atrial fibrillation (AF), renal failure, hypertensive encephalopathy, and aortic dissection were less than one percent at 30 days. The study was published online on July 7, 2016, in Annals of Emergency Medicine.

“We encourage patients to monitor their blood pressure at home if they have been diagnosed with hypertension, but not every high blood pressure reading is an emergency,” said lead author emergency physician Clare Atzema, MD, of Sunnybrook Health Sciences Centre. “Some of the increase in emergency visits is due to the aging of our population, but we suspect that recent public education campaigns recommending home blood pressure monitoring may have inadvertently contributed to the rise in visits for hypertension.”

“Patients should be aware that unless their high blood pressure coincides with symptoms of a medical emergency, such as chest pain, severe headache, nausea or shortness of breath, they probably do not need to visit the ER,” concluded Dr. Atzema. “We of course encourage them to follow up as soon as possible with their regular physician; if there is any doubt, come to the emergency department. We would rather have you come without an emergency than stay home with one.”

Related Links:
Sunnybrook Health Sciences Centre
University of Toronto