And you don’t need to be sent to “time out” – i.e., referred to the Emergency Department – solely because of it.
This is a retrospective, single-center report regarding the incidence of adverse events in patients found to have “hypertensive urgency” in the outpatient setting. This was defined formally as any systolic blood pressure measurement ≥180 mmHg or diastolic measurement ≥110 mmHg. Their question of interest was, specifically, whether patients referred to the ED received clinically-important diagnosis (“major adverse cardiovascular events”), with a secondary interest in whether their blood pressure was under better control at future outpatient visits.
Over their five-year study period, there were 59,535 patient encounters meeting their criteria for “hypertensive urgency”. Astoundingly, only 426 were referred to the Emergency Department. Of those referred to the ED, 2 (0.5%) received a MACE diagnosis within 7 days, compared with 61 (0.1%) of the remaining 58,109. By 6 months, MACE had equalized between the two populations – now 4 (0.9%) in the ED referral cohort compared with 492 (0.8%) in those sent home. Hospital admission, obviously, was higher in those referred to the ED, but apparently conferred a small difference in blood pressure control in follow-up.
The authors go on to perform a propensity-matched comparison of the ED referrals to the sent home cohort, but this is largely uninsightful. The more interesting observation is simply that these patients largely do quite well – and any adverse events probably happen at actuarial levels rather than having any specific relationship to the index event.
I appreciate how few patients were ultimately referred to the Emergency Department in this study; fewer than 1% is an inoffensive number. That said, zero percent would be better.
“Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting”
http://archinte.jamanetwork.com/article.aspx?articleid=2527389
We must have gotten all 426 at my ED. We see this all the time!