Evaluation, management, and referral of elderly emergency department patients with elevated blood pressure.

ABSTRACT

OBJECTIVES: To determine blood pressure (BP) reassessment rates and to describe the evaluation and outpatient referral rates of elderly emergency department (ED) patients with elevated BP. METHODS: This was a retrospective cohort of patients who were at least 60 years, presented with a systolic BP of at least 140 mmHg or diastolic BP at least 90 mmHg, and were discharged from the ED. BP measurements, ancillary testing, and discharge instructions were obtained from a random selection of medical records. RESULTS: Of 267 patients 198 (74%) underwent a BP reassessment. Factors associated with a reassessment included receipt of an antihypertensive, symptom of chest pain, care in an ED with a BP reassessment protocol, and increasing age. Of the 241 patients who maintained an elevated BP, 88 (37%) had no prior history of hypertension, 36 (15%) had a prior history but had untreated hypertension, and 117 (49%) had known, treated, but poorly controlled hypertension. Ancillary testing was completed on 144 (60%) patients and only 24 patients received an antihypertensive medication while in the ED. These patients had higher systolic (177 vs. 156 mmHg) and diastolic values (98 vs. 84 mmHg) than those who did not receive antihypertensive medications (P<0.01). At discharge, 29 (12%) patients received a directed referral and 28 (12%) received any intervention, with the provision of antihypertensive prescription the most common in 17 (7%). CONCLUSION: Unlike other ED-based studies of adult hypertensive patients, BP reassessment in the elderly occurred in the majority. Referral and intervention rates, however, were low.