title: Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort.
abstract: OBJECTIVE
  The objective is of the study to evaluate the effect of antihypertensive therapy in emergency department (ED) patients with markedly elevated blood pressure (BP) but no signs/symptoms of acute target organ damage (TOD).
  
  
  METHODS
  This is a retrospective cohort study of ED patients age 18 years and older with an initial BP greater than or equal to 180/100 mm Hg and no acute TOD, who were discharged with a primary diagnosis of hypertension. Patients were divided based on receipt of antihypertensive therapy and outcomes (ED revisits and mortality) and were compared.
  
  
  RESULTS
  Of 1016 patients, 435 (42.8%) received antihypertensive therapy, primarily (88.5%) oral clonidine. Average age was 49.2 years, and 94.5% were African American. Treated patients more often had a history of hypertension (93.1% vs 84.3%; difference = -8.8; 95% confidence interval [CI], -12.5 to -4.9) and had higher mean initial systolic (202 vs 185 mm Hg; difference = 16.9; 95% CI, -19.7 to -14.1) and diastolic (115 vs 106 mm Hg; difference = -8.6; 95% CI, -10.3 to -6.9) BP. Emergency department revisits at 24 hours (4.4% vs 2.4%; difference = -2.0; 95% CI, -4.5 to 0.3) and 30 days (18.9% vs 15.2%; difference = -3.7; 95% CI, -8.5 to 0.9) and mortality at 30 days (0.2% vs 0.2%; difference = 0; 95% CI, -1.1 to 0.8) and 1 year (2.1% vs 1.6%; difference = -0.5; 95% CI, -2.5 to 1.2) were similar.
  
  
  CONCLUSIONS
  Revisits and mortality were similar for ED patients with markedly elevated BP but no acute TOD, whether they were treated with antihypertensive therapy, suggesting relative safety with either approach.
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, MI; Cardiovascular Research Institute, Wayne State University, Detroit, MI. Electronic address: plevy@med.wayne.edu.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
authors.affiliation: Internal Medicine, St Joseph Mercy Ann Arbor, Ann Arbor, MI.
authors.forename: James J
authors.initials: JJ
authors.lastname: Mahn
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Joseph
authors.initials: J
authors.lastname: Miller
authors.affiliation: Department of Emergency Medicine, Akron General Medical Center, Akron, OH.
authors.forename: Alicia
authors.initials: A
authors.lastname: Shelby
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, MI.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brody
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Russell
authors.initials: R
authors.lastname: Davidson
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Burla
authors.affiliation: Michigan State University College of Osteopathic Medicine, East Lansing, MI.
authors.forename: Alexander
authors.initials: A
authors.lastname: Marinica
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, MI; Wayne State University School of Medicine, Detroit, MI; Department of Emergency Medicine, University of Illinois Medical Center, Chicago, IL.
authors.forename: Justin
authors.initials: J
authors.lastname: Carroll
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, MI; Internal Medicine, St Joseph Mercy Ann Arbor, Ann Arbor, MI.
authors.forename: John
authors.initials: J
authors.lastname: Purakal
authors.affiliation: Cardiovascular Research Institute, Wayne State University, Detroit, MI; Department of Internal Medicine, Wayne State University, Detroit, MI.
authors.forename: John M
authors.initials: JM
authors.lastname: Flack
authors.affiliation: Department of Emergency Medicine, Wayne State University, Detroit, MI.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Welch
mesh_terms: D000208:Acute Disease; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents