Review of Referrals Sent to the Emergency Department for Management of Hypertension

Hypertensive urgencies, unlike hypertensive emergencies, are severe episodes of hypertension without evidence of end-organ damage. Most recent guidelines advise against referring patients with hypertensive urgencies to the emergency department (ED) for treatment. There is a lack of Canadian data surrounding whether referrals to the ED regarding hypertension are appropriate. We analyzed referrals to the Montfort Hospital ED due to hypertension and assessed if they met the criteria for hypertensive emergencies. This was a retrospective chart study of all ED visits at Montfort Hospital from the 2016 fiscal year with a final diagnosis/chief complaint of hypertension. Charts were assessed to determine if these patients met the criteria for having true hypertensive emergencies. Out of the 54,000 visits to the Montfort ED, 254 reported hypertension as a final diagnosis/chief complaint. Of those, 67 patients had been referred by a healthcare practitioner, while 187 were self-referred. None of the referred patients met the criteria for hypertensive emergency; however, eight of these patients did have symptoms indicating a possibility of hypertensive emergency. Six of the self-referred patients met criteria for hypertensive emergency. The majority (71.6%) of patients referred did not require on-site antihypertensive treatment, and 37.3% of patients were sent home with new outpatient prescriptions. All the cases referred to the Montfort ED for hypertension were considered hypertensive urgencies and none of them required ED hypertensive treatment. Further investigation is required to help optimize appropriate patient referral to the ED for true hypertensive emergencies and improve management of hypertensive urgencies in the community.