Blood Pressure Decrease Prior to Initiating Pharmacological Therapy in Nonemergent Hypertension

In order to characterize the decrease in blood pressure that occurs in the emergency department (ED) setting in cases of nonemergent hypertension before beginning pharmacological therapy, 94 consecutive cases of hypertension seen at the University of Illinois Hospital were reviewed. Each patient in the analysis had a triage blood pressure recorded by the nursing staff and second blood pressure reading taken between 10 minutes and 2 hours after the triage pressure before pharmacological therapy was begun. Patients with diastolic pressures less than 90 mm Hg were excluded, as were patients with acute end-organ pathology secondary to hypertension. In the remaining 54 cases, the mean arterial pressure fell by 6% (P less than .003), the systolic pressure fell by 6% (P less than .022), and the diastolic pressure fell by 6.4% (P less than .003), suggesting that in nonemergent hypertension, a significant decrease in blood pressure occurs in the ED before pharmacological therapy is begun. The blood pressure decrease was not statistically different when sex and age were considered, but when patients were grouped into those with diastolic pressures between 90 mm Hg and 114 mm Hg and those with diastolic pressures greater than or equal to 115 mm Hg, there was a statistically significant decrease in systolic, diastolic, and mean arterial pressures only in patients with diastolic pressures greater than or equal to 115 mm Hg. Our findings suggest that patients with nonemergent hypertension do not always require immediate and aggressive pharmacological intervention in the ED setting and are best observed for a short period and then reassessed before beginning pharmacological therapy.