Written by Clay Smith
Almost half of adults had an elevated BP measurement when in the ED, but even when ≥160/100, this did not increase risk of adverse cardiovascular outcomes within 2 years.
Why does this matter?
We know patients who come to the ED solely for hypertension have excellent short term outcomes. And lots of patients have an elevated BP reading in the ED. It’s stressful! But do high BP readings in the ED portend future bad outcomes?
Yes, it’s up. No, your head won’t explode.
This was a retrospective look at patients in a single center with an elevated BP reading in the ED who were followed up province-wide for bad outcomes, specifically a composite of stroke/TIA, ACS, new heart failure, or death over the next two years. Of 30,278 adult patients seen and discharged from the ED, almost half of them had an elevated BP measurement in the ED; roughly ¼ with BP ≥160/100 were subsequently diagnosed with hypertension and later started on an antihypertensive. Based on raw numbers, those with BP ≥160/100 had a higher rate of the composite outcome, but that went away with adjustment for other known cardiac risk factors, aHR 0.84 (95%CI 0.71 to 1.004) within 2 years.
Elevated Blood Pressures Are Common in the Emergency Department but Are They Important? A Retrospective Cohort Study of 30,278 Adults. Ann Emerg Med. 2021 Feb 9;S0196-0644(20)31363-9. doi: 10.1016/j.annemergmed.2020.11.005. Online ahead of print.
4 thoughts on “Yes, Your BP Is Up. No, It Doesn’t Matter.”
Looking at this article, my biggest comment is that, while ED HTN may not be associated with adverse cardiovascular outcomes over 2 years, it is associated with longstanding HTN. For reference, see this article published last year: https://pubmed.ncbi.nlm.nih.gov/32508176/ (this article also mentions a similar correlation of ED HTN and eventual diagnosis of HTN). Two years may not be long enough to actually see any of the adverse outcomes we worry about with HTN.
So, while your elevated BP doesn’t matter now, it may matter 5-10 years from now. I’m in the camp that a quick talk with patients about their blood pressure is probably worth it in the long run.
Great point. It needs to be addressed and followed up.
No, strictly speaking, it doesn’t matter at that moment. However, it may be time to reflect on the fact that in many of our patient populations, patients’ primary care relationships are tenuous, if existent at best. I work in a lower SES area of Toronto, Canada, where, it may surprise many to hear that perhaps half of my patients or more have essentially no relationship with a family doctor. That may be generous in the wake of COVID, where many family practitioners/ GPs have not seen patients in person in a year. NO, the patient may not have a CVA or MI in the next two years. What happens down the road with renal failure and dementia, aortic disease and the like. No, I probably don’t start anything in the department. However, unless you have your head buried in the sand you make CERTAIN that the patient understands your concerns and that that there is some pragmatic plan for follow-up.