Emergency Medical Minute

Contributor: Aaron Lessen, MD

Educational Pearls:

• Many patients present to the ED with elevated BP

• Many are referred from outpatient surgery centers or present after an elevated measurement at home

• Persistent questions on the best way to treat these patients

• The AHA published a scientific statement on the management of elevated BP in the acute care setting

• Hypertensive emergencies: SBP/DBP >180/110–120 mm Hg with evidence of new or worsening target-organ damage

• Includes aortic dissection or subarachnoid hemorrhage

• Require aggressive treatment

• Asymptomatic markedly elevated inpatient BP: SBP/DBP >180/110–120 mm Hg without evidence of new or worsening target-organ damage AND asymptomatic elevated inpatient BP: SBP/DBP ≥130/80 mm Hg without evidence of new or worsening target-organ damage

• No benefits to urgent treatment in the ED, but there are harms to treating patients in this manner

• These patients do not require IV medications

• Provide reassurance and instructions on following up with their PCP to manage their BP in the outpatient setting

• Removed the term “hypertensive urgency”

References

1. Bress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. 2024;81(8). doi:https://doi.org/10.1161/hyp.0000000000000238

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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