Hypertension in the ED

This is specificlaly if there is NO END ORGAN DAMAGE.

assessment : check for end organ damage

  • brain
    • history: seizure, confusion, stroke
  • kidneys
    • history: haematuria?
    • investigations: urine dip - proteinuria, haematuria
  • heart
    • history: chest pain
    • investigations: ECG
  • eyes
    • history: ???
    • investigations: papilloedema LOL GOOD LUCK

stand there and do nothing

  • No evidence of better outcome with lowering BP in absence of end organ damage - Campos et al 2018 (Systematic review)
  • VALUE trial Julius et al 2004
  • Anderson et al 2023: intensive treatment of hypertension in inpatients (n= 60,000!) - greater risk of adverse events

if you do give something, give something that will work soon...

  • doxazosin
  • metoprolol
  • nifedipine
  • thinking about the timeframe for amlodipine...

not just hypertension for these guys

  • pregnant patients → pre-eclampsia
  • spinal cord injury → autonomic dysreflexia
    • look for constipation, urinary retention etc.
  • acute aortic dissection - hopefully it's obvious why.

#cardio

https://www.rcemlearning.co.uk/reference/hypertensive-emergencies/
https://www.rcemlearning.co.uk/foamed/treat-or-hold-decoding-high-blood-pressure-in-the-emergency-room/
https://thesgem.com/2026/01/sgem-paper-in-a-pic-499/ - Todd et al. Antihypertensive prescription is associated with improved 30-day outcomes for discharged hypertensive emergency department patients. J Am Coll Emerg Physicians Open. 2024