May 17, 2021
Background: A patient presents to the emergency department (ED) for medical treatment. After comprehensive evaluation and management, the patient’s condition improves and you prepare to discharge the patient home. The nurse notifies you the blood pressure (BP) is 185/105 and asks if you are comfortable discharging the patient in light of the abnormal vital signs.
This clinical scenario happens regularly in the ED. Our training in emergency medicine has always been: “We do not treat asymptomatic hypertension in the ED.” In fact, ACEP’s 2013 Clinical Policy statement recommends referring patients with asymptomatic hypertension for outpatient follow-up and NOT starting antihypertensive therapy in the ED. However, this tends to be a controversial topic with various clinical opinions and practices. Ask ten emergency medicine physicians: What BP value would make you uncomfortable when discharging a patient? You may get ten different answers.
Patient safety is paramount. Furthermore, individual physicians have varying levels of risk tolerance and aversion which contribute to treatment decisions. This paper attempts to address concerns in patients with elevated blood pressure readings in the ED....Read More