We investigated this very question, which was published in the April issue of JACEP Open (“Antihypertensive prescription is associated with improved 30-day outcomes for discharged hypertensive emergency department patients”). In a retrospective study of 93,512 hypertensive patients discharged from eight EDs, we asked whether prescription anti-hypertensive therapy was associated with a decreased risk of an adverse event (aortic dissection, acute heart failure, myocardial infarction, stroke, and hypertensive encephalopathy) within 30 days of discharge. Consistent with prior studies, we observed a low risk of events, with an adverse outcome occurring in just 0.7 percent of patients within 30 days mortality was 0.1 percent. This should reassure EPs that discharging hypertensive patients is safe.

Despite the overall low rate of adverse outcomes, we found that ED prescription of anti-hypertensive therapy can further lower the risk of an adverse outcome. Prescribing antihypertensive therapy was associated with lower odds of severe adverse outcomes within 30 days (0.2 percent) compared to the group not receiving a prescription (0.7 percent), equating to a number needed to treat of 183 to prevent one adverse outcome. Most of this observed benefit was due to a decrease in heart failure events.

Additionally, we observed a lower rate of ED revisits in the treatment group (15.5 percent) compared to the group that was not treated (10 percent), with a number needed to treat of 18 to prevent one 30-day revisit to the ED. Our results indicate that while the current practice of deferring care to primary care physicians is safe, there may be an opportunity to improve outcomes for discharged hypertensive patient.

Based on our observations, a lower threshold to prescribe anti-hypertensive therapy has the potential to both prevent 30-day severe adverse outcomes in this population and to decrease ED returns. Due to its retrospective study design, these findings require confirmation with prospective trials, and further study is also needed to investigate which specific anti-hypertensives are optimal. Given the enormous number of ED patients found to have elevated BP, a more aggressive approach to the treatment of incidentally noted ED hypertension could have significant positive effects on a population-wide scale if these findings are confirmed.

Dr. Todd is the associate residency program director at William Beaumont University Hospital.

References

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