High blood pressure alone is not an emergency. Definitely something to be concerned about preventing/treating in the long term, but no blood pressure number alone warrants an ambulance without also having symptoms of something like a heart attack or stroke that indicates organ damage.
That said, that kind of blasé approach to markedly elevated blood pressure with no real plan to reassess or find a root cause is still unacceptable, especially lazily blaming it on menstruation like is so common. So not trying to undermine your experience, I just had to chime in bc the “hypertensive crisis” thing is a pet peeve of mine.
Yeah this very much depends on the actual specific number. I work inpatient so I don’t blink at 155 systolic because we’re gonna take it again in 12h and honestly these days the hospitalist says current evidence supports not even treating emergently until 170. The ED actually keeps insisting that 180 isn’t their problem for patients they want admitted to psych. A small dentists office might not be up to date on current best practice for treating hypertension.
When I interviewed for a CSU they were even like “how would you approach an intake where your new pt has a BP of 180?” and I, coming from the university hospital where I had residents subject to my whims I struggled to come up with an answer that wasn’t “page the oncall I guess?” But I did manage “…tell them to take some deep breaths and take it again…?” which was apparently the right answer???
150s to me is a GP/PCP’s problem 3 months from now and ultimately they’ll probably just tell the person to start with eating less salt. It also sounds like it was asymptomatic and there’s also the possibility that the doctor just figured she wouldn’t take anything anyway based on this person’s description.
No seriously, there is no number that you need to treat emergently without accompanying signs of end-organ damage. The AHA recommends considering “permissive hypertension” even for SBPs over 180. So you could be 220/180 and if no other symptoms or signs of organ damage, you should get treated the same as someone who is 145/95, and even then that’s only if the hypertension is chronic. The only difference is it will probably take a lot more meds to chronically control someone whose bp is that extreme.
Yeah >180 is definitely serious, I may have overstated myself there trying to make my point. If you read that high, it’s recommended to contact your doctor asap, but not to seek emergency treatment unless you’re having symptoms.
Current (but limited) evidence actually suggests some harm caused by unnecessarily treating asymptomatic markedly elevated blood pressure, and low risk of acute (hours to days) adverse events caused directly by the hypertension.
I’m a PharmD who works in the ED at a large teaching hospital. I have this conversation often.
A great “Things We Do For No Reason” article about the topic. (There’s even one article in this paper that specifically talks about patients with systolic >220, only 0.2% of which had a negative vascular outcome at 7 days without inpatient treatment.) I highly recommend this paper. The folks at SHM/JHM do great work with this series.
Every lady’s experience in a red state. Seriously, I’m not making a joke, being a “conservative” as defined in the US political system NEEDS to be categorized as a mental disorder that precludes people from being doctors at the least.
High blood pressure alone is not an emergency. Definitely something to be concerned about preventing/treating in the long term, but no blood pressure number alone warrants an ambulance without also having symptoms of something like a heart attack or stroke that indicates organ damage.
That said, that kind of blasé approach to markedly elevated blood pressure with no real plan to reassess or find a root cause is still unacceptable, especially lazily blaming it on menstruation like is so common. So not trying to undermine your experience, I just had to chime in bc the “hypertensive crisis” thing is a pet peeve of mine.
Yeah this very much depends on the actual specific number. I work inpatient so I don’t blink at 155 systolic because we’re gonna take it again in 12h and honestly these days the hospitalist says current evidence supports not even treating emergently until 170. The ED actually keeps insisting that 180 isn’t their problem for patients they want admitted to psych. A small dentists office might not be up to date on current best practice for treating hypertension.
When I interviewed for a CSU they were even like “how would you approach an intake where your new pt has a BP of 180?” and I, coming from the university hospital where I had residents subject to my whims I struggled to come up with an answer that wasn’t “page the oncall I guess?” But I did manage “…tell them to take some deep breaths and take it again…?” which was apparently the right answer???
150s to me is a GP/PCP’s problem 3 months from now and ultimately they’ll probably just tell the person to start with eating less salt. It also sounds like it was asymptomatic and there’s also the possibility that the doctor just figured she wouldn’t take anything anyway based on this person’s description.
No seriously, there is no number that you need to treat emergently without accompanying signs of end-organ damage. The AHA recommends considering “permissive hypertension” even for SBPs over 180. So you could be 220/180 and if no other symptoms or signs of organ damage, you should get treated the same as someone who is 145/95, and even then that’s only if the hypertension is chronic. The only difference is it will probably take a lot more meds to chronically control someone whose bp is that extreme.
AHA’s 2024 review article for reference
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Yeah >180 is definitely serious, I may have overstated myself there trying to make my point. If you read that high, it’s recommended to contact your doctor asap, but not to seek emergency treatment unless you’re having symptoms.
Current (but limited) evidence actually suggests some harm caused by unnecessarily treating asymptomatic markedly elevated blood pressure, and low risk of acute (hours to days) adverse events caused directly by the hypertension.
I’m a PharmD who works in the ED at a large teaching hospital. I have this conversation often.
Recommendations from the AHA directly to patients/lay persons
A great “Things We Do For No Reason” article about the topic. (There’s even one article in this paper that specifically talks about patients with systolic >220, only 0.2% of which had a negative vascular outcome at 7 days without inpatient treatment.) I highly recommend this paper. The folks at SHM/JHM do great work with this series.
Every lady’s experience in a red state. Seriously, I’m not making a joke, being a “conservative” as defined in the US political system NEEDS to be categorized as a mental disorder that precludes people from being doctors at the least.
There are so many misogynists in the center (we don’t have a real left) that the orange idiot beat two women.