Students Scientific Group, 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Emergency Department, University Hospital in Krakow, Kraków, Poland.
Kardiol Pol. 2024;82(4):407-415. doi: 10.33963/v.phj.100025. Epub 2024 Apr 12.
The prevalence of uncontrolled hypertension remains a significant concern in public healthcare systems, including daily practices of emergency departments (ED).
We aimed to characterize patients admitted to an ED for elevated blood pressure (BP) and to identify factors leading to hospitalization.
This retrospective analysis included all patients admitted to an ED in a tertiary hospital in 2022 due to an acute BP rise without hypertensive emergencies.
The studied group (n = 570) constituted 1.5% of all ED admissions in 2022. The median age was 67 years (Q1-Q3) (52-75), 68.9% were females. Systolic BP (200 mm Hg [180-212]) and diastolic BP (105 mm Hg [100-115]) at home were higher than during triage (173 mm Hg [160-190] and 95 mm Hg [84-103], respectively [P <0.0001]). Thirty-nine percent of the studied population had taken BP-lowering agents before ED admission (captopril in 91.8% of cases). In the ED, nitrendipine (54.2%), captopril (38.1%), furosemide (16.3%), urapidil (10.0%), and nitroglycerine (1.9%) were administered. Eventually, a median of 140/82 mm Hg BP was reached in the median time of 288 minutes (202-400). Hospitalization was necessary in 5.4% of patients. The need for furosemide or urapidil administration in the ED doubled the risk of hospitalization (OR, 2.0; P <0.01). Before ED admission, only 17.0% of patients received guidelines-recommended single-pill combination therapy, and 17.6% had already visited ED for uncontrolled hypertension (median of 388 days earlier).
Elevated BP is a common reason for admission to the ED. Crucially, improvements in long-term hypertension treatment and education are needed to reduce the number of patients seeking ED care for elevated BP.
在公共医疗体系中，包括急诊科日常实践中，未得到控制的高血压患病率仍然是一个重大问题。
我们旨在描述因急性血压升高而被收入急诊科的患者，并确定导致住院的因素。
这项回顾性分析纳入了 2022 年因急性血压升高而无高血压急症收入一家三级医院急诊科的所有患者。
研究组（n=570）占 2022 年所有急诊科入院患者的 1.5%。中位年龄为 67 岁（Q1-Q3：52-75），68.9%为女性。家庭自测收缩压（200mmHg[180-212]）和舒张压（105mmHg[100-115]）高于分诊时的测量值（分别为 173mmHg[160-190]和 95mmHg[84-103]，P<0.0001）。39%的研究人群在急诊科就诊前服用过降压药物（91.8%为卡托普利）。在急诊科，使用了硝苯地平（54.2%）、卡托普利（38.1%）、呋塞米（16.3%）、乌拉地尔（10.0%）和硝酸甘油（1.9%）。中位时间为 288 分钟（202-400）时，中位血压达到 140/82mmHg。5.4%的患者需要住院治疗。在急诊科需要使用呋塞米或乌拉地尔会使住院的风险增加一倍（OR，2.0；P<0.01）。在急诊科就诊前，只有 17.0%的患者接受了指南推荐的单片复方制剂治疗，17.6%的患者因未控制的高血压而已经来过急诊科（中位数为 388 天前）。
升高的血压是急诊科收治的常见原因。至关重要的是，需要改善长期高血压治疗和教育，以减少因升高的血压而寻求急诊科治疗的患者数量。
