Moderate-to-severe blood pressure elevation at ED entry
Hypertension or normotension?
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Fig. 1
Time course of systolic BP (A) and diastolic BP (B) during ED stay (filled squares, hypertensive patients; open squares, normotensive patients). Data are given as mean ± SD. *P < .05 and **P < .01 vs BP value at entry into the ED. #P < .05 and ##P < .01 normotensive vs hypertensive patients.
Fig. 2
Diagnostic accuracy of averaged BP measurements for different periods. A and B, Comparison of diagnostic accuracy at different periods for systolic (A) and diastolic (B) BP measurements. The areas under the receiver operator characteristic curve are given together with the 95% CIs. C and D, Receiver operator characteristic curve showing the sensitivity and specificity of different BP cutoff values for the screening for AHT by averaged BP values taken between minutes 60 and 80 after entry into the ED for systolic (C) and diastolic (D) BP measurements.
Abstract
Purpose
It is controversial whether arterial hypertension (AHT) can be diagnosed in the emergency department (ED). We sought to prospectively investigate the natural time course of blood pressure (BP) to define an optimal period for AHT screening in ED patients with an elevated initial BP.
Procedures
Patients with a BP greater than 160/100 mm Hg upon ED admission underwent repeated BP measurements every 5 minutes for 2 hours using an automated device. Arterial hypertension was confirmed using 12-hour ambulatory BP measurement or repeated office BP measurement according to the Joint National Committee VII guidelines by the primary care physician after discharge from the hospital.
Main Findings
Systolic BP decreased significantly during the first 10 to 20 minutes of ED stay in hypertensive and normotensive patients without further significant changes thereafter. Diastolic BP remained stable in both hypertensive and normotensive patients. Discrimination between hypertensive and normotensive patients was best between minutes 60 and 80 after ED admission. An average BP of 165/105 mm Hg or higher during this period strongly suggests AHT whereas a BP of less than 130/80 mm Hg excludes AHT with high sensitivity.
Conclusions
Screening for AHT in the ED is possible with high specificity and sensitivity. Blood pressure measurements between minutes 60 and 80 after entry into the ED yield the highest diagnostic value.
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