"Hypertension SBP ≥ 180 DBP ≥ 110 (& asymptomatic) urgency not so urgent"
I have seen many patients with high blood pressure and no symptoms (headache, epistaxis, faintness, psychomotor agitation, chest pain, dyspnoea, and neurologic deficit) who, with treatment, have lived long healthy lives. I have learnt not to panic and start gradual treatment. When I have “panicked” and started high dose medication I have sometimes caused harm through hypotension.
This study had over 2 million office visits and 4.6% met the definition of hypertensive urgency (SBP ≥ 180 DBP ≥ 110 & asymptomatic).1 They compared a matched sample of 426 patients sent to hospital with 852 who were not. At 7, 30 & 180 days there was no difference in cardiovascular events. Patients sent home had more uncontrolled hypertension at 1 month but not 6 months. Patients sent home had fewer admissions at 7 and 30 days. Visits to emergency departments were associated with more hospitalisations.
Iona Heath from the UK has a great editorial on the topic.2
- Patel KK et al Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. JAMA Intern Med. Click here
- Iona Heath. Hypertensive Urgency - Is This a Useful Diagnosis? JAMA Intern Med 2016. Click here
Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.