title: Safety and efficacy of antihypertensive prescription at emergency department discharge.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The objective was to evaluate the safety and efficacy of prescribing antihypertensive therapy from the ED.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brody
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Tahsin
authors.initials: T
authors.lastname: Rahman
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Brian
authors.initials: B
authors.lastname: Reed
authors.affiliation: 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.
authors.forename: Scott
authors.initials: S
authors.lastname: Millis
authors.affiliation: Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, MI.|Division of Translational Research and Clinical Epidemiology and Department of Medicine, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Brian
authors.initials: B
authors.lastname: Ference
authors.affiliation: Division of Translational Research and Clinical Epidemiology and Department of Medicine, Wayne State University School of Medicine, Detroit, MI.|Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI.
authors.forename: John M
authors.initials: JM
authors.lastname: Flack
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI.|Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000959:Antihypertensive Agents