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Clinical Pearl Wednesday #84

Hypertension High Blood Pressure  - stevepb / Pixabay

Have a patient with a blood pressure >180/110? Have you diagnosed them with hypertensive urgency? Considering sending them to the ER? Think again…

Asymptomatic hypertensive “urgency” should probably not be treated as urgency. In patients with a systolic BP > 220 that presented to the ER, only 0.2% had a major event 7 days after discharge from the ER.

Instead of sending the patient to the ER and having them wrap up thousands of dollars in medical bills, consider rest, outpatient anti-hypertensives, and routine follow up.

I will routinely start these patients on combination anti-hypertensive medication outpatient and have them return for blood pressure rechecks daily for 3-4 days. Most of the time, the patient will experience a significant decrease in their blood pressure without ill effect, and will be thankful you didn’t sent them to the ER unnecessarily. Even when I work in the ER I just roll my eyes when we get patients from their PCP or an urgent care for a blood pressure of 190/110… I do nothing but give them clonidine and send them home. I have NEVER had an issue. A full workup on an asymptomatic hypertensive patient is a waste of time, money, and resources in the vast majority of cases.

As always though, use your own clinical judgement!

10 Responses

  1. Do you do any testing to check for any end organ damage?
    What symptoms will have you send to ER? I know chest pain, stroke like symptoms but do you send for headache, ringing in ears, etc?
    Thank you😊

    1. No need to check for end organ damage if they are assymptomatic. Yes, if they are having symptoms like severe headache (mild headache is common and not a big deal), neurological deficits, decrease in urine output/hematuria, chest pain, SOB, etc… then send them to the ER. If their BP is REALLY high like 220/140, then I will send that to the ER.

  2. I totally agree with this. We have so many who does not adhere to treatment and most time Clonidine will bring them down in clinic , but the follow ups are extremely important.

    Thank you for sharing your knowledge

    1. You are welcome 🙂 You are right, just a little clonidine will usually do the trick. This is all we do in the ER the vast majority of the time.

  3. I am starting my telehealth program, what tools can be used to assess through video conferencing ie b/p . I am interesting in taking telehealth and mens health course are the courses discounted now!

    1. Adrienne,

      You would need remote vital signs monitoring equipment, which gets expensive… Just have the patient obtain vitals at an urgent care or have them purchase a small BP cuff to use. Do not complicate this. If you complicate it, you will not get patients.

      If you want a 20% bundle discount since you are purchasing 2 courses, email me 🙂

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