Brody Aaron, Rahman Tahsin, Reed Brian, Millis Scott, Ference Brian, Flack John M, Levy Phillip D
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI.
Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI.
Acad Emerg Med. 2015 May;22(5):632-5. doi: 10.1111/acem.12660. Epub 2015 Apr 22.
Poor blood pressure (BP) control is a primary risk factor for target organ damage in the heart, brain, and kidney. Uncontrolled hypertension is common among emergency department (ED) patients, particularly in underresourced settings, but it is unclear what role ED providers should play in the management of chronic antihypertensive therapy.
The objective was to evaluate the safety and efficacy of prescribing antihypertensive therapy from the ED.
This was a retrospective study of data pooled from two prospective, longitudinal, randomized controlled trials, both of which enrolled ED patients with asymptomatic hypertension. Antihypertensives were prescribed at emergency physician discretion, and this was not related to randomization arm. Demographic data, BP at screening and randomization visit, and data on adverse effects potentially related to antihypertensive therapy were compiled. Means were compared using Student's t-tests, and proportions were compared using chi-square tests. The effect of antihypertensive therapy on BP control was further analyzed using multivariable regression modeling controlling for age, race, sex, hypertension history, study cohort, and ED BP.
Data were abstracted for 217 subjects. The median interval from ED visit to randomization was 12 days. Seventy-six subjects (35%) received one or more prescriptions for antihypertensive therapy. Age, sex, race, hypertension history, and mean duration of hypertension were equivalent between groups. Although mean ED BP was higher among those who received prescriptions, the mean systolic BP (sBP) reduction from ED to randomization was significantly greater (difference = 19 mm Hg, 95% confidence interval = 12 to 26 mm Hg). No patient in either group had an sBP less than 100 mm Hg at randomization. On multiple regression modeling, randomization sBP reduction was independently associated with antihypertensive prescription (p = 0.001). The incidence of adverse effects was equivalent and low in both groups. No new neurological deficits, ischemic events, or life-threatening anaphylactic reactions were reported in either group.
Prescription of antihypertensive medication from the ED is associated with significantly lower sBP at short-term outpatient follow-up. Antihypertensive therapy was not associated with an increased incidence of adverse events, and BP reduction did not exceed potentially harmful levels. Initiation of chronic antihypertensive therapy in the ED is safe and effective and may be a reasonable consideration for at-risk populations.
血压控制不佳是心脏、大脑和肾脏靶器官损害的主要危险因素。急诊患者中，尤其是在资源匮乏地区，高血压控制不佳很常见，但尚不清楚急诊医护人员在慢性抗高血压治疗管理中应发挥何种作用。
评估在急诊室开具抗高血压治疗药物的安全性和有效性。
这是一项回顾性研究，数据来自两项前瞻性、纵向、随机对照试验，这两项试验均纳入了无症状高血压的急诊患者。抗高血压药物由急诊医生酌情开具，与随机分组无关。收集人口统计学数据、筛查和随机分组访视时的血压，以及与抗高血压治疗可能相关的不良反应数据。采用学生t检验比较均值，采用卡方检验比较比例。使用多变量回归模型进一步分析抗高血压治疗对血压控制的影响，该模型控制了年龄、种族、性别、高血压病史、研究队列和急诊室血压。
提取了217名受试者的数据。从急诊就诊到随机分组的中位间隔时间为12天。76名受试者（35%）接受了一种或多种抗高血压治疗处方。两组之间的年龄、性别、种族、高血压病史和高血压平均病程相当。虽然接受处方的患者急诊室平均血压较高，但从急诊室到随机分组时收缩压（SBP）的平均降幅明显更大（差值 = 19 mmHg，95%置信区间 = 12至26 mmHg）。随机分组时，两组均无患者收缩压低于100 mmHg。在多变量回归模型中，随机分组时收缩压降低与抗高血压处方独立相关（p = 0.001）。两组不良反应发生率相当且较低。两组均未报告新的神经功能缺损、缺血性事件或危及生命的过敏反应。
在急诊室开具抗高血压药物与短期门诊随访时收缩压显著降低相关。抗高血压治疗与不良事件发生率增加无关，血压降低未超过潜在有害水平。在急诊室启动慢性抗高血压治疗是安全有效的，对于高危人群可能是一个合理的选择。
