Emergency Medical Minute6 Jan 2025

Episode 938: AHA Policy on Management of Elevated Blood Pressure (BP) in the Acute Care Setting

Contributor: Aaron Lessen, MD

Educational Pearls:

Many patients present to the ED with elevated BP

Many are referred from outpatient surgery centers or present after an elevated measurement at home

Persistent questions on the best way to treat these patients
The AHA published a scientific statement on the management of elevated BP in the acute care setting

Hypertensive emergencies: SBP/DBP >180/110–120 mm Hg with evidence of new or worsening target-organ damage

Includes aortic dissection or subarachnoid hemorrhage
Require aggressive treatment

Asymptomatic markedly elevated inpatient BP: SBP/DBP >180/110–120 mm Hg without evidence of new or worsening target-organ damage AND asymptomatic elevated inpatient BP: SBP/DBP ≥130/80 mm Hg without evidence of new or worsening target-organ damage

No benefits to urgent treatment in the ED, but there are harms to treating patients in this manner
These patients do not require IV medications
Provide reassurance and instructions on following up with their PCP to manage their BP in the outpatient setting

Removed the term "hypertensive urgency"

References

Bress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. 2024;81(8). doi:https://doi.org/10.1161/hyp.0000000000000238

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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