Hypertension and Pokemon
Your patient referred to the ED for isolated hypertension would like to be discharged so they can find a Pokemon near the ED. Most of us have a sense that patients with an ED visit solely for hypertension do just fine. ED visits for hypertension increased in frequency during the ten-year study period. Subsequent complications after the ED visit were vanishingly small. Ninety-day mortality was <1%. “Together hospitalizations for stroke, heart failure, acute myocardial infarction, atrial fibrillation, renal failure, hypertensive encephalopathy, and dissection were less than 1% at 30 days.”
Take these patients seriously and consider the possibility of end-organ damage. Be extra careful about patients with a flimsy follow up plan, i.e. homeless or indigent. They need our advocacy. ACEP did an author interview worth reading and quoted Dr. Atzema, who said, “If there is any doubt, come to the emergency department: we would rather have you come without an emergency than stay home with one.”
Patients with ED visits solely for hypertension fare extremely well. Few need admission, and most do great with oral agents and close follow up.
Ann Emerg Med. 2016 Jul 1. pii: S0196-0644(16)30165-2. doi: 10.1016/j.annemergmed.2016.04.060. [Epub ahead of print]
1Division of Emergency Medicine, the Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
3Division of Emergency Medicine, the Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address:email@example.com.
Patients treated primarily for hypertension are common in the emergency department (ED). The outcomes of these patients who were given a primary ED diagnosis of hypertension have not been described at a population level. In this study, we describe the characteristics and outcomes of these patients, as well as changes over time.
This retrospective cohort study used linked health databases from the province of Ontario, Canada, to assess ED visits made between April 1, 2002, and March 31, 2012, with a primary diagnosis of hypertension. We determined the annual number of visits, as well as the age- and sex-standardized rates. We examined visit disposition and assessed mortality outcomes and potential hypertensive complications at 7, 30, 90, and 365 days and at 2 years subsequent to the ED visit.
There were 206,147 qualifying ED visits from 180 sites. Visits increased by 64% between 2002 and 2012, from 15,793 to 25,950 annual visits, respectively. The age- and sex-standardized rate increased from 170 per 100,000 persons to 228 per 100,000 persons during the same period, a 34% increase. Eight percent of visits ended in hospitalization, but this proportion decreased from 9.9% to 7.1% during the study period. Mortality was very low: less than 1% within 90 days, 2.5% within 1 year, and 4.1% within 2 years. Among subsequent hospitalizations for potential hypertensive complications, stroke was the most frequent admitting diagnosis, but the frequency was still less than 1% at 1 year. Together hospitalizations for stroke, heart failure, acute myocardial infarction, atrial fibrillation, renal failure, hypertensive encephalopathy, and dissection were less than 1% at 30 days.
The number of visits made primarily for hypertension has increased significantly during the last decade. Although some of the increase is due to aging of the population, other forces are contributing to it as well. Subsequent mortality and complication rates are low and have declined. With current practice patterns, the feared complications of hypertension are extremely infrequent.
Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
PMID: 27395439 [PubMed – as supplied by publisher]