High blood pressure is not a flashy diagnosis, but this charting template explaining it to patients was my most used. By far.
Unless a patient has hypertensive encephalopathy or evidence of other target-organ damage, we usually don’t think of high blood pressure as an emergency department problem.
We have learned that the management of asymptomatic elevated blood pressure is best kept in the wheelhouse of primary care providers. Just look at the classic article by Shayne & Pitts which tells us that in these cases “the most important intervention is to ensure proper follow-up”. Or the ACEP clinical policy which says that “patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up”.
But acknowledging high BP and having patients take action can have lasting effects.
A challenge with this, however, is remembering that there was a high reading floating around somewhere in a patient’s ED course and alerting them to it amidst the tumult and multiple other issues that brought them to see you. To unload having to remember this task, if I saw an elevated blood pressure at any time and a patient’s ED course, and the patient did not carry the diagnosis of blood pressure, I took two actions:
- Immediately populate their ED diagnosis list with “Elevated blood pressure without history of hypertension.”
- Populate their discharge instructions with the following phrase…
Your blood pressure was noted to be elevated on today’s evaluation. This does not mean that you have chronic high blood pressure as the reading could be related to the events which led to your emergency department visit. However, I recommend that you check your blood pressure a few times a day, keep a record of the readings, and take this record to your primary care provider on the next appointment.** At that time, you and your primary care provider can discuss any further action that needs to be taken.
Sometimes I was able to discuss this with the patient, but not infrequently I frankly forgot. If I did discuss it, I recommended this blood pressure cuff to them. There’s not anything special about it. I just found this configuration to be easy to use, fairly accurate, and relatively inexpensive. It’s also similar to what I have at home.
**The time period in which they should follow up is put elsewhere in the chart and usually dictated by the chief complaint. But for high BP alone, I recommended it within a week. If really high, within a few days.