Home and pharmacy blood pressure readings promote ED visits

Reference

Atzema CL, Wong A, Masood S, et al. The characteristics and outcomes of patients who make an emergency department visit for hypertension after use of a home or pharmacy blood pressure device. Ann Emerg Med 2018;72(5):534-543.

Synopsis

This retrospective study included all adults who made an ED visit to 1 of 5 hospitals in Ontario, Canada, and who received a primary diagnosis of hypertension. The median blood pressure upon presentation was 182/97 mm Hg among the 1508 patients. Home blood pressure readings prompted the ED visit in 40.9% of these patients. Another 8.3% were prompted by a pharmacy blood pressure reading, and the rest of the visits were prompted either by a physician referral or were not documented. Many patients reported general symptoms, including headache (38%), dizziness (30%), and chest pain (16%). The average blood pressure at home was 190/100 mm Hg though it dropped to 171/88 mm Hg by the second ED measurement; in pharmacy-identified high blood pressure, the average reported blood pressure was 185/100 mm Hg , dropping eventually to 169/94 mm Hg. Despite lack of evidence of benefit and recommendations to the contrary, 41% of patients received antihypertensive treatment in the ED. Only 3.1% of patients with home- or pharmacy-prompted visits were admitted as compared with 11.9% of physician referrals and 11.0% of patients with undocumented reasons for visiting. Over the next year, 11% of patients initially discharged from the ED made another ED visit for high blood pressure.