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
I agree. What meds do you use?
I like amlodophine and lisinopril or losartan.
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😊
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.
What combo meds are your go to?
Amlodopine and lisinopril or losartan
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
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.
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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.
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