By Dr. Yasir Abunamous,
DocReady Primary Care and Urgent Care Physician
As the most common disease seen in the emergency department, I run into a lot of patients who are concerned about their elevated blood pressure.
Elevated blood pressure is anything more than 120/80.
Elevated blood pressure is rarely a crisis. In fact, it typically takes decades for hypertension to cause the most notable diseases such as kidney problems, vision loss, heart attack, and strokes.
On many occasions, an asymptomatic, middle-aged patient comes into the emergency department with concerns for his or her elevated blood pressure that they casually may have noted while strolling through the grocery store and randomly decided to have it checked.
My goal here is not to downplay the long term effects of hypertension, but instead to bring light to how we as emergency room doctors evaluate this issue. The American College of Emergency Physicians (ACEP) creates guidelines for all emergency medicine physicians to follow. Basically, it says that if a person is asymptomatic (no chest pain, visual changes, confusion, dizziness), then the person should keep documentation and follow up with their primary care physician. The physician can then run through the log of multiple blood pressure records from various dates and see if starting a blood pressure medication is the right choice for them.
Blood pressure varies minute by minute and is impacted by multiple factors including stress, time of day, position, and hydration status, and therefore a more thorough investigation needs to take place prior to placing someone on lifelong medication.
To diagnose hypertension, a patient must have multiple elevated blood pressures checked over multiple visits on separate dates; Typically, this translates into a patient visit to a doctor’s office who notes an elevated blood pressure reading and recommends that the patient return in 1 to 2 weeks for repeat evaluation.
Though controversial, the emergency department has not set a real marker of where we delineate hypertension levels — other disciplines in medicine have demarcated that systolic blood pressure (upper number) more than 220 OR diastolic (lower) blood pressure more than 110 is an emergency but many of times when these persons are sent to the ED from their doctor’s offices their blood pressure has either come down or persists because they are in this cycle of stress due to elevated pressure which in turn is causing their blood pressure to rise more or third and usually uncommonly they are calm and their blood pressure persists to stay high. Typically the last of the three have been living with this high of blood pressure for years, if not decades and now that they finally had an assessment/physical exam this finding has been unmasked.
Unfortunately, approximately 10 percent of the population are uninsured which means that they do not have a primary care physician to help manage this issue which only leads to a more dangerous situation.
To reiterate, my goal is not to downplay the dangers of high blood pressure but instead make people aware that it takes an active role to figure out if someone actually has hypertension. It means being involved in your own health care, actively monitoring and keeping a log of your blood pressure, and taking the right steps to have it addressed. In this medically advanced society, people should not be burdened due to complications of hypertension especially now that online telemedicine services have taken off.
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In the end, if you are unsure of what to do and feel that you need to go to your local emergency department then do not hesitate to; we would gladly care for you via a telemedicine visit here at DocReady.
Acep guidelines 1) In patients with asymptomatic markedly elevated blood pressure, routine ED medical intervention is not required. (2) In select patient populations (eg, poor follow-up), emergency physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control. [Consensus recommendation] (3) Patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up.
Dr. Yasir Abunamous (“Dr. A”) is a Family Physician who specializes in patient-centered care leveraging the strengths and resources of each individual to optimize and maintain health, and endeavors to restore health during times of illness. He treats patients of all ages (including newborns and infants), with experience in pediatrics and women’s health in addition to general medicine. When not at work, Dr. A spends much of his free time with his beloved family, community members, and friends.