Features August 2016 Issue

Hypertensive Urgency Doesn’t Always Require Hospitalization

A Cleveland Clinic study finds that patients whose blood pressure spikes sharply may be treated safely and effectively with outpatient therapy.

The rate of major adverse cardiovascular events, such as stroke or heart attack, is relatively low among patients who experience hypertensive urgency. Because of that, these patients can be safely treated with outpatient care instead of being hospitalized, according to a Cleveland Clinic study published recently in JAMA Internal Medicine.

Hypertensive urgency is a situation in which your systolic blood pressure (the top number in your blood pressure reading) is at least 180 mm Hg or your diastolic pressure (bottom number) is at least 110 mm Hg.

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A blood pressure spike could damage organs.

Hypertensive urgency differs from a hypertensive emergency in that there is no organ damage with hypertensive urgency. In a hypertensive emergency, a patient may start to suffer damage to the kidneys, eyes and other parts of the body.

In the study, Cleveland Clinic cardiology resident Krishna Patel, MD, found that many patients experiencing hypertensive urgency, but no symptoms or organ damage, are sent to hospital emergency rooms, go through unnecessary testing, and are often admitted.

“For the practicing clinician, our results support treating these patients by following them serially as an outpatient,” Dr. Patel says. She adds, however, that the study found that these patients often had poorly controlled blood pressure in the months following their visit to a doctor, regardless of where they were treated.

“High blood pressures by themselves should not trigger immediate referral to the emergency department,” Dr. Patel says. “At the same time, we found that physicians did a poor job of controlling these same patients’ blood pressures over the next six months. It seems that they were too worried about short-term complications, and not worried enough about longer-term ones. More emphasis should be placed on better outpatient follow-up for these very difficult-to-control hypertensive patients.”

When Blood Pressure Spikes

If you take your blood pressure at home and it’s in that 180/110 area, seek medical attention immediately. If you are having symptoms, such as chest pain, shortness of breathing, difficulty seeing or speaking, dizziness or weakness, call 911—or have someone close to you call 911. If you have no other symptoms than a high blood pressure reading, wait a few minutes and take your pressure again. Then call your doctor’s office.

If it’s still elevated, but you continue to have no symptoms, you may be advised to go to the emergency room anyway or see your doctor that day. If your blood pressure is much lower after a second reading, you may be advised to continue monitoring it. If it’s over 180/110, call 911.

Do not change your medication on your own. If you’re concerned about a possible hypertensive crisis, call 911. It’s always better to err on the side of caution when it comes to blood pressure.

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