Emergency Department Hypertension Management: Effects of Routine Oral Antihypertensive Agents on Emergency Management of Hypertension

Hypertensive patients account for approximately 1-25% of annual emergency department visits . While this figure varies by region, hypertensive patients are among the groups that contribute significantly to emergency department crowding and workload . Hypertensive emergencies constitute about 0.3-0.9% of all patients, and this number is rapidly increasing each year .

The 2017 AHA hypertension guidelines emphasize that severe elevations in blood pressure (hypertensive crisis and hypertensive urgency) do not require emergency department visits or referrals unless there is end-organ damage . It is noted that treatment in these patients typically involves dose adjustment or a change in medication .

The 2023 ESC hypertension guidelines recommend that in patients presenting to the emergency department with a hypertensive crisis, blood pressure should be gradually lowered with oral agents over a 24-48 hour period. These patients do not usually require hospital admission but can be monitored in an outpatient setting for clinical evaluation. It is noted that their blood pressure may remain elevated upon discharge from the emergency department, and follow-up in a clinic is necessary for reevaluation of chronic therapy .

Some studies have indicated that both oral and intravenous treatments are preferred for patients presenting with hypertensive crises, highlighting that the approach can vary from physician to physician .

When evaluating literature reviews, published guidelines, and conducted studies, it is observed that there are differences between European and American approaches in defining and treating hypertensive crisis, as well as variability in physician management of these patients .