Patient Requests to Treat Uncontrolled Chronic Hypertension in the Emergency Department

Updated guidelines from the American Heart Association (AHA) and American College of Emergency Physicians (ACEP) encourage, rather than discourage, the treatment of chronic hypertension (HTN) in ED patients being discharged home. However, little is known about how often ED patients request treatment for their uncontrolled chronic HTN and how often ED physicians respond to such requests.

We conducted a cross-sectional analysis of the 2016–2022 National Hospital Ambulatory Medical Care Survey (NHAMCS). We included ED visits by non-hospitalized U.S. adults (≥18 years) with a known history of HTN and at least one markedly elevated blood pressure during the visit (triage systolic ≥160 mm Hg and/or diastolic ≥100 mm Hg). Visits with evidence of acute emergencies (eg, myocardial infarction, stroke, heart failure, kidney failure, encephalopathy, substance toxicity, or pregnancy-related HTN disorders) were excluded using ICD-10 codes. We examined the relationship between patient-reported reason for visit and ED antihypertensive prescriptions.

From 2016 through 2022, there were an estimated 46,467,981 ED visits by patients with uncontrolled chronic HTN. Overall, 19.5% (95% confidence interval [CI], 17.5–21.6) of visits resulted in an antihypertensive prescription. ED visits in which patients reported HTN as a reason for the visit were significantly more likely to result in an antihypertensive prescription compared with visits for non–hypertension-related complaints (38.6% [95% CI, 34.3–43.1] vs 15.4% [95% CI, 13.3–17.8]; odds ratio [OR], 3.01; 95% CI, 2.32–3.90; p

ED physicians are more likely to treat uncontrolled chronic HTN when patients explicitly request treatment. Enhancing systems that support the consistent identification of uncontrolled chronic HTN can improve adherence to emerging management guidelines.