Elevated blood pressure in the emergency department: lack of adherence to clinical practice guidelines

ObjectivesTo determine emergency physician's adherence to American College of Emergency Physicians policy recommendations in the assessment of patients with asymptomatic elevated blood pressure (BP) in the emergency department (ED).MethodsRetrospective study at a level 1 academic ED. Adult nontrauma patients with an initial systolic BP of at least 140mmHg and/or diastolic BP of at least 90mmHg, who were subsequently discharged from the ED were included. Patients were excluded if they had chest pain, shortness of breath, neurologic symptoms, or were pregnant.ResultsA total of 179 (female-102, male-77) patients met eligibility criteria with a mean age of 44 years17.9 (SD). BP remained elevated in 71% (117/164) of the subjects that received repeat measurements at the time of discharge. Seventeen percent (28/164) had severe BP elevation (systolic BP160 or diastolic BP100) at the time of discharge. No association was found between pain scores and BP readings in triage (P=0.35). Complete end organ damage evaluation was performed in 3% (5/179). Only 6% (11/179) of patients were informed of elevated BP in the ED. Specific BP-related discharge instructions were given to only 5% (10/179) of patients. Follow-up with a primary care physician for re-evaluation of elevated BP was recommended in 6% (11/179).ConclusionA vast majority of ED patients with persistently elevated BP did not receive BP counseling and referral for further evaluation of elevated BP, suggesting lack of adherence to American College of Emergency Physicians policy recommendations in the assessment of ED patients with asymptomatic elevated BP.