Yes, Your BP Is Up. No, It Doesn’t Matter.

March 5, 2021

Written by Clay Smith

Spoon Feed
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.

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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.

Source
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.