Hypertensive ED patients: Missed opportunities for addressing hypertension and facilitating outpatient follow-up

Winders, W. Tyler; Ariizumi, Ren; Hart, Kimberly W.; Elder, Nancy C.; Lyons, Michael S.; Lindsell, Christopher J.; Adeoye, Opeolu

doi:10.1016/j.ajem.2018.09.030

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…While the safety of prescribing antihypertensives to ED patients has been demonstrated, to our knowledge, no prior study has demonstrated improved short-term outcomes in this population. 2,4,6,9 The low rate (4.7%) of patients prescribed antihypertensive therapy in our study is less than the rate observed in prior studies, which range from 6 to 35%. 8,9 Antihypertensive medication was more likely to be prescribed to patients in a younger cohort, to black patients, and to males.…”

Section: Discussioncontrasting

confidence: 76%

“…AEs were defined as acute aortic catastrophes (aortic dissection and aortic aneurysm rupture), acute heart failure, hemorrhagic stroke, ischemic stroke, hypertensive encephalopathy, myocardial infarction, and death. Thirty days was chosen as a reasonable time frame for most US patients to follow up with a primary care physician for continued management of their HTN and is consistent with previously reported follow‐up times 4 …”

Section: Methodsmentioning

confidence: 98%

“…Thirty days was chosen as a reasonable time frame for most US patients to follow up with a primary care physician for continued management of their HTN and is consistent with previously reported follow-up times. 4…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Additionally, up to one third of ED patients with elevated BP have no prior history of HTN 3 . It is important that emergency physicians (EPs) optimally manage and ensure outpatient follow up for this patient population due to an increased risk of poor outcomes including myocardial infarction, stroke, heart failure, renal failure, and death 4,5 . In addition to an increased risk of adverse events (AEs), hypertensive patients have a high rate of short‐term revisit to the ED 5 .…”

Section: Introductionmentioning

confidence: 99%

“…3 It is important that emergency physicians (EPs) optimally manage and ensure outpatient follow up for this patient population due to an increased risk of poor outcomes including myocardial infarction, stroke, heart failure, renal failure, and death. 4,5 In addition to an increased risk of adverse events (AEs), hypertensive patients have a high rate of short-term revisit to the ED. 5 The risk of these AEs can be reduced with adequate long-term BP control, making the ED an environment with the potential to improve outcomes for hypertensive patients.…”

Section: Introductionmentioning

confidence: 99%

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Antihypertensive prescription is associated with improved 30‐day outcomes for discharged hypertensive emergency department patients

Todd,

Xing,

Zhao

et al. 2024

JACEP Open

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BackgroundHypertension (HTN) is common in discharged emergency department (ED) patients, yet the short‐term outcomes of treating HTN at ED discharge are unclear. This study aimed to investigate whether emergency physician (EP) prescription of oral antihypertensive therapy at ED discharge for hypertensive patients is associated with a decreased 30‐day risk of the severe adverse events (AEs), death, and revisits to the ED.MethodsWe conducted an observational cohort study assessing the 30‐day outcomes of discharged ED patients with HTN, comparing outcomes based on whether antihypertensive therapy was prescribed. All discharged adult ED patients from an eight‐hospital system with a diagnosis of HTN from January 2016 to February 2020 were screened, and consisted of a mix of suburban and urban patients with broad ethnic and socioeconomic backgrounds. Patients were categorized into the treatment group if they received a prescription for antihypertensive medication at ED discharge. The primary outcome was severe composite AEs from HTN (aortic catastrophe, heart failure, myocardial infarction, hemorrhagic and ischemic stroke, or hypertensive encephalopathy) within 30 days of ED discharge. The secondary outcomes were death or ED revisit over the same period.ResultsThe study sample consisted of 93,512 ED visits; 57.5% were female, and mean age was 59.3 years. 4.7% of patients were prescribed antihypertensive treatment at ED discharge. Within 30 days, 0.7% of patients experienced an AE, 0.1% died, and 15.2% had an ED revisit. The treatment group had significantly lower odds of AE (adjusted odds ratio [aOR]: 0.224, 95%CI 0.106–0.416, p < 0.001), and ED revisits (aOR: 0.610, 95%CI 0.547–0.678, p < 0.001), adjusting for age, race, degree of HTN, ED treatment for elevated HTN, Elixhauser comorbidity index, and heart failure history. There was no difference in odds of death 30 days after discharge.Conclusion and relevancePrescription antihypertensive therapy for discharged ED patients is associated with a 30‐day decrease in severe adverse events and ED revisit rate.

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