Is the immediate blood pressure control using parenteral antihypertensive drug needed for patients with severe high blood pressure with epistaxis in the emergency department?
- Authors
- Shin, Kyunghoon; Park, Kyunghoon; Lee, Heekyung; Kim, Changsun; Kim, Laurie Seiwon; Yoo, Ji Won
- Issue Date
- Oct-2022
- Publisher
- 대한응급의학회
- Keywords
- Epistaxis; Severe high blood pressure; Hypertensive crisis
- Citation
- 대한응급의학회지, v.33, no.5, pp.471 - 479
- Indexed
- KCI
- Journal Title
- 대한응급의학회지
- Volume
- 33
- Number
- 5
- Start Page
- 471
- End Page
- 479
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/185983
- ISSN
- 1226-4334
- Abstract
- Objective: This study aimed to assess whether the conventional treatments administered in the emergency department (ED) for hypertensive urgencies (observed or peroral [PO]-controlled) in severe high blood pressure (BP) patients with epistaxis increase the incidence of epistaxis recurrence and the mortality rate as compared to immediate BP control using intravenous (IV) antihypertensive medication Methods: A retrospective study over 7 years was conducted at the ED of a tertiary university hospital. Among adult patients with spontaneous epistaxis, subjects with severe high BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) were included in the study. Participants were divided into three groups determined by the methods used to control BP: non-controlled, PO-controlled, and IV-controlled groups. The incidence of epistaxis recurrence and mortality rate within 6 months were compared.
Results: Among the 380 patients enrolled, 238 were discharged from the ED without any pharmacological antihypertensive treatment (non-controlled group), 83 received PO antihypertensive medication (PO-controlled group), and 59 received IV antihypertensive medication (IV-controlled group). Of these, 29 (12.2%), nine (10.8%), and seven (11.9%) patients from the non-controlled, PO-controlled, and IV-controlled groups, respectively, experienced epistaxis recurrence within 24 hours, which was statistically not different among the three groups (P=0.948). The 6-month mortality rates were determined to be 0.8%, 2.4%, and 3.4% in the non-controlled, PO-controlled, and IV-controlled groups, respectively. The difference was also not significant among the groups (P=0.294).
Conclusion: The conventional treatments of hypertensive urgencies (observed or PO-controlled) in patients with severe high BP with epistaxis in the ED did not increase the incidence of epistaxis recurrence and short-term mortality rate when compared to immediate BP control using IV antihypertensive medication.
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