Abstract
Study objective
In the Emergency Department (ED) setting, clinicians commonly treat severely elevated
blood pressure (BP) despite the absence of evidence supporting this practice. We sought
to determine if this rapid reduction of severely elevated BP in the ED has negative
cerebrovascular effects.
Methods
This was a prospective quasi-experimental study occurring in an academic emergency
department. The study was inclusive of patients with a systolic BP (SBP) > 180 mm Hg
for whom the treating clinicians ordered intensive BP lowering with intravenous or
short-acting oral agents. We excluded patients with clinical evidence of hypertensive
emergency. We assessed cerebrovascular effects with measurements of middle cerebral
artery flow velocities and any clinical neurological deterioration.
Results
There were 39 patients, predominantly African American (90%) and male (67%) and with
a mean age of 50 years. The mean pre-treatment SBP was 210 ± 26 mm Hg. The mean change
in SBP was −38 mm Hg (95% CI −49 to −27) mm Hg. The average change in cerebral mean
flow velocity was −5 (95% CI −7 to −2) cm/s, representing a −9% (95% CI −14% to −4%)
change. Two patients (5.1%, 95% CI 0.52–16.9%) had an adverse neurological event.
Conclusion
While this small cohort did not find an overall substantial change in cerebral blood
flow, it demonstrated adverse cerebrovascular effects from rapid BP reduction in the
emergency setting.
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Article Info
Publication History
Published online: August 22, 2018
Accepted:
August 20,
2018
Received in revised form:
August 20,
2018
Received:
April 12,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
