A new study published in the Journal of the American Medical Association—Internal Medicine shows patients being treated for acutely high blood pressure might not fare any differently when they are treated in the hospital versus outpatient treatment.
The study authors looked at nearly 60,000 patients who came into all Cleveland Clinic Healthcare system doctors' offices with blood pressure higher than 180/110 from 2008 to 2013, but no other serious symptoms. Very few (426) patients were sent to the ER or admitted to the hospital for treatment, while the rest were sent home with lifestyle change instructions or drug adjustments.
But the patients who went straight to the hospital didn’t see their blood pressure return to normal any more quickly or on a longer-term basis than the patients who went home, the study found. Most patients from both groups still had hypertension six months after their initial office visits, but a low incidence of major adverse cardiovascular events.
Not only did the patients who ended up in the emergency room not see any better short-term health outcomes, they were contributing to higher healthcare costs without much purpose. The study authors also pointed out that up to 3 percent of all ER visits are due to hypertensive urgency—these findings could mean it is possible to eliminate some or all of those visits altogether.
The researchers did recommend, however, that physicians pursue outpatient treatment for these cases. In the long-term, uncontrolled hypertension can cause organ failure and predict death from heart failure. In this study, the patients who were sent home did receive such treatment and advice.