Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort

ObjectivesThe objective is of the study to evaluate the effect of antihypertensive therapy in emergency department (ED) patients with markedly elevated blood pressure (BP) but no signs/symptoms of acute target organ damage (TOD).MethodsThis is a retrospective cohort study of ED patients age 18 years and older with an initial BP greater than or equal to 180/100 mm Hg and no acute TOD, who were discharged with a primary diagnosis of hypertension. Patients were divided based on receipt of antihypertensive therapy and outcomes (ED revisits and mortality) and were compared.ResultsOf 1016 patients, 435 (42.8%) received antihypertensive therapy, primarily (88.5%) oral clonidine. Average age was 49.2 years, and 94.5% were African American. Treated patients more often had a history of hypertension (93.1% vs 84.3%; difference = − 8.8; 95% confidence interval [CI], − 12.5 to − 4.9) and had higher mean initial systolic (202 vs 185 mm Hg; difference = 16.9; 95% CI, − 19.7 to − 14.1) and diastolic (115 vs 106 mm Hg; difference = − 8.6; 95% CI, − 10.3 to − 6.9) BP. Emergency department revisits at 24 hours (4.4% vs 2.4%; difference = − 2.0; 95% CI, − 4.5 to 0.3) and 30 days (18.9% vs 15.2%; difference = − 3.7; 95% CI, − 8.5 to 0.9) and mortality at 30 days (0.2% vs 0.2%; difference = 0; 95% CI, − 1.1 to 0.8) and 1 year (2.1% vs 1.6%; difference = − 0.5; 95% CI, − 2.5 to 1.2) were similar.ConclusionsRevisits and mortality were similar for ED patients with markedly elevated BP but no acute TOD, whether they were treated with antihypertensive therapy, suggesting relative safety with either approach.