While hypertension has been thoroughly studied in the general population, there has been surprisingly little study of patients who come to the emergency room with hypertension. “The emergency room offers a good opportunity to identify such patients and refer them for further evaluation and treatment, said David Karras, M.D., professor of emergency medicine at Temple University School of Medicine.
Some experts advise a fully battery of tests to rule out hypertension-related organ damage, a course that doesn’t necessarily lend itself to the fast-paced, urgent atmosphere of the ER.
"Some emergency doctors feel passionately that we're obligated to provide comprehensive care because we are often the only health care some people get, particularly those who are economically disadvantaged,” said Karras. “Others believe that we are not primary care physicians and we owe it to all of the patients in the emergency room to provide efficient, but not comprehensive, care."
Karras recently completed a companion study on how high blood pressure is treated in the ER at the same four urban academic medical centers. He found that despite expert recommendations to conduct a full battery of tests, the majority of patients with hypertension in academic emergency rooms do not undergo such evaluation, are not given blood pressure medication, and are not advised on how to manage their blood pressure after discharge.
His research is now focused on developing better guidelines for the evaluation and management of hypertension in the ER. Of the patients visiting the ER during the study period, 20 percent or 1400, had elevated blood pressure, which is above 140/90. Thirty percent of this group had severely elevated blood pressure, above 180 /110. And while many assume that the ER experience itself increases blood pressure, for one-third of study participants and half of those with severely elevated blood pressure, the hypertension remained weeks after the ER visit.
MEDICA.de; Source: Temple University School of Medicine