Blood Pressure Hikes Lead to Spikes in ED Visits

By Jonathan Springston, Associate Managing Editor, AHC Media

The rise of public monitoring stations and home testing equipment has led more people to be mindful of their blood pressure. However, when blood pressure readings increase, many rush to the ED seeking treatment. But according to recent data, physicians send most of those patients home because there’s no need for further tests or treatment.

A group of Canadian researchers studied thousands of ED visit records in Ontario that occurred from 2002 to 2012. During that period, researchers discovered that ED visits for high blood pressure leaped from about 16,000 to about 26,000. However, the percentage of patients visiting an ED for high blood pressure who ended up hospitalized decreased from 10% to 7% over the same period. Ultimately, researchers discovered that about one in every 600 patients who visited an ED for high blood pressure died within a week. Two years after such a visit, only 4.4% were dead.

“The number of visits made primarily for hypertension has increased significantly during the last decade. Although some of the increase is due to aging of the population, other forces are contributing to it as well. Subsequent mortality and complication rates are low and have declined. With current practice patterns, the feared complications of hypertension are extremely infrequent,” the authors concluded.

Blood pressure monitoring is important, as consistently high readings could lead to a variety of medical maladies if left untreated. However, this new research adds to growing concerns about unfounded fears and artificially high blood pressure readings.

In the Jan. 30 issue of Internal Medicine Alert, Harold Karpman, MD, FACC, FACP, explored an analysis from the Dallas Heart Study, expanding on the concepts of white-coat hypertension and masked hypertension. Essentially, researchers believe that anxiety, body position, and other factors may lead to artificially high blood pressure readings in a doctor’s office setting as opposed to readings gauged out of the office where patients may feel more comfortable, which in turn could lead to lower (and perhaps more realistic) readings.

In the April and May issues of Clinical Briefs, Louis Kuritzky, MD, wrote further on this notion, analyzing a pair of studies that concluded artificially high blood pressure readings taken in a physician’s office result in too many unnecessary hypertension diagnoses, which then leads to inflated spending on superfluous medication.

“It has been recognized for more than a decade that blood pressure elevation as defined by ambulatory blood pressure monitoring (ABPM) is a much stronger predictor of cardiovascular outcomes than office blood pressure measurement,” Dr. Kuritzky wrote in April. “We should follow the lead of our U.K. colleagues and perform ABPM (or at least home blood pressure monitoring) on a much more routine basis.”

In May, he concluded, “Concordant with recent U.S. Preventive Services Task Force recommendations, clinicians should routinely use ABPM or home blood pressure monitoring prior to initiating treatment for hypertension.”

For more on the latest Canadian analysis, be sure to check out upcoming issues of Clinical Cardiology Alert and ED Management.