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Original Research
Incidence and Management of Asymptomatic Hypertensive Urgency at a VA Emergency Department
Dr. Dowd is an Ambulatory Clinical Pharmacy Specialist at The Johns Hopkins Hospital in Baltimore, Maryland. Dr. Gallagher is an Ambulatory Clinical Pharmacy Specialist at the Tallahassee Veterans Affairs Health Care Center in Florida. Dr. Kessler is Professor of Medicine at Duke University in Durham, North Carolina, and is affiliated with the Durham VAMC. Dr. Svingos is the Emergency Medicine Clinical Pharmacist at North Florida South Georgia Veterans Health System in Gainesville, Florida. Correspondence: Dr. Svingos (robert.svingos@gmail.com)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
A small subset of patients reported positive pain scores at triage but did not describe acute pain. Pain scores are highly subjective, and few primary literature sources link chronic pain with increased BP.22,23 Nevertheless, patients who reported acute pain and elevated BP were excluded in order to identify truly asymptomatic patients. VA hospitals are unique health systems and data obtained from this study might not be applicable to other public or private facilities. Last, the study did not take into account patients’ psychosocial circumstances that might have fostered a disproportionate reliance on the ED for health care.
Conclusion
Asymptomatic patients with elevated BP are treated in the ED despite no evidence supporting improved outcomes after acute BP lowering in this population. Follow-up after ED encounters for AH did not occur consistently within guideline-recommended 7 days, a trend that also occurs in non-VA systems.8 Clinics and health care systems could establish policies to prevent or minimize management of AH in the ED. Ideally, AH should be managed in a clinic setting by a PCP, but growing clinician workload might lead to increasing wait times and difficultly obtaining same-day appointments. Nurse-led clinics and clinical pharmacists operating under a scope of practice and working closely with a PCP are a cost-effective solution to ensure timely treatment and appropriate follow-up of patients with uncontrolled hypertension.
Acknowledgments This material is the result of work supported with resources and the use of facilities at the North Florida South Georgia Veterans Health System in Gainesville, Florida.
