Hey, its ERP from ER stories doing a guest rant post.
OK, I have blogged about this before, but nearly every shift, I have cases which emphasize the need to repeat myself.
When the hell with doctors learn to stop obsessing about hypertension? I don’t mean to say that we should not treat it – of course we should. I am talking about blaming every symptom a patient is having on it. I am talking about aggressive lowering of the BP in the acute setting. It is just stupid.
If I had a nickle for every time a patient’s headache or dizziness is attributed to hypertension I would be a millionaire. The sad truth is that it almost never is! The BP is a REACTION to the symptoms not the cause. This is obviously true in people who are chronically hypertensive – it took years for them to develop it so why do we think we need it lowered in 5 minutes? Of course their pressure will go up to 200 when they have pain. And guess what, lowering it fast will probably make new problems - like syncope and rebound hypertension caused by crappy old drugs like Clonidine.
This is different than when a young person has hypertensive encephalopathy or when someone has a big head bleed (where you want to lower the pressure only a small amount) or an aortic dissection. They people do need IV treatment but almost no one else does!
I just had a patient who was admitted to three days in England (where he was visiting I assume) for “hypertensive emergency” because he was having a room spinning sensation and a systolic pressure of over 200. Guess what, they lowered his pressure and gave him new drugs to go home with but he still had dizziness! Why? He had obvious benign positional vertigo! I gave him antivert (an antihistamine that works well for it) and it went away! And as a bonus, his pressure came down on its own!
So, patients do not check your BP when you feel pain or dizziness (unless you are on the verge of passing out – in which case you are looking to see if your BP is LOW), check it when you feel normal and have been chilling out for 10-15 minutes. Do that over several weeks and show the numbers to your doctors and let him or her decide treatment.
Doctors, do not attribute every headache, vertiginous episode, or other discomfort referable to the head to hypertension. Do not agressively lower it in the ER or your office and then discharge the patient. Do not give someone labatelol because the have a nose bleed. Do not fail to examine someone and miss benign positional vertigo. Don’t just treat the number to make yourself feel better! Treat hypertension for the long term!