Can Diastolic Blood Pressure Decrease in Emergency Department Setting be Anticipated?

Introduction: There are no obvious guidelines for therapy of elevated blood pressure (BP) in the emergency department (ED). Diastolic BP is probably more difficult to control compared with systolic BP. Aim: To characterize patients who respond with a significant decrease in diastolic BP in the ED, whether treated or not. Methods: In this retrospective cohort study, all patients attending a tertiary care ED with elevated BP were evaluated. Clinical characteristics of patients in whom diastolic BP decreased ≥20% were compared with those in whom diastolic BP decreased <20%. Results: Overall, 391 patients were included in the final analysis (64% females), of which diastolic BP of 106 (27%) patients decreased ≥20%. Patients in whom diastolic BP decreased ≥20% were older (70.1 ± 13 years vs. 65.9 ± 16.7 years, P = 0.011) and had a history of ischemic heart disease (IHD) and cerebrovascular disease (CVA) prior to the ED visit [30 patients (28.3%) vs. 45 patients (15.8%) for a history of IHD, P = 0.005 and 16 patients (15.1%) vs. 21 patients (7.4%) for CVA, P = 0.02]. Conclusions: A history of IHD is associated with a higher decrease in diastolic BP irrespective of the use of medical treatment during the ED visit whereas a history of TIA/CVA was associated with a higher decrease in diastolic BP only in patients who were treated in the ED.