Blood pressure response to medical treatment in the emergency department - a retrospective cohort study.
OBJECTIVE
It is unclear whether blood pressure (BP) without target organ damage should be decreased in patients in the emergency department (ED). It is also uncertain whether any certain class of medications has an advantage over the other in this setting. This study addressed both these questions.


METHODS
In this retrospective cohort study, all patients attending a tertiary care ED with elevated BP were evaluated. All patients with target organ damage as well as those with significant active co-morbidities, such as myocardial ischemia, were excluded. Baseline characteristics and response of BP to therapy were compared between those treated and untreated in the ED. In addition, BP response to therapy was compared between different classes of antihypertensive medications.


RESULTS
Overall, 438 patients were included in the final analysis (62% female), of which 275 (63%) were treated in the ED. Antihypertensive medications were more commonly prescribed in the ED for those with higher systolic and diastolic BP, but other baseline characteristics were similar between the two groups. Only systolic BP significantly decreased in those treated with antihypertensive medications compared with those untreated. The most commonly used classes were angiotensin converting enzyme inhibitors (ACEis) and calcium channel blockers (CCBs). Use of either of these drug classes was not associated with a significant decrease in either systolic or diastolic BP compared with the use of other drug classes.


CONCLUSIONS
Antihypertensive drug therapy is more commonly prescribed in the ED in individuals with both elevated systolic and diastolic BP, but leads to a significant decrease only in systolic BP. Use of either ACEis or CCBs is not associated with a significant decrease in either systolic or diastolic BP compared with other drug classes.
a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
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Ayalon-Dangur
b Bio-statistical Institute, Rabin Medical Center , Beilinson Campus, Petah Tikva , Israel.
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Shohat
a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|c Department of Internal Medicine A , Rabin Medical Center , Petah Tikva , Israel.
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Gafter-Gvili
a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|d The Department of Emergency Medicine , Rabin Medical Center , Beilinson Campus, Petah Tikva , Israel.
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Shiber
a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|e Department of Internal Medicine E , Rabin Medical Center , Petah Tikva , Israel.
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Grossman
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination / Q000379:methods; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers
Blood pressure; emergency department; medications; treatment