New research in JAMA Internal Medicine suggests sending certain hypertensive ambulatory patients to the hospital, rather than home, may be the wrong call.
In a study of one Cleveland Clinic office settings, researchers looked at all patients between 2008 and 2013 who presented with hypertensive urgency — blood pressure measures elevated enough to potentially cause organ damage. Of the more than two million patient visits that occurred in the five-year window, 58,000 met the criteria for hypertensive urgency and were included in the final study group.
However, of that group, only 426 patients were referred to the hospital. When the researchers matched that patient group with 852 other study participants who were sent home from the ambulatory setting, they found no significant difference in major adverse cardiovascular events in the six months following the study.
"In the absence of symptoms of target organ damage, most patients probably can be safely treated in the outpatient setting because cardiovascular complications are rare in the short term," the authors concluded. "Furthermore, referral to the ED was associated with increased use of healthcare resources but not better outcomes."
The researchers also found patients sent home were at lower risk of seven-day readmission than those admitted to the hospital before being discharged.