FP077COMPARISON OF EARLY EFFECTS BETWEEN REST AND ANTIHYPERTENSIVE MEDICATION IN PATIENTS WITH HYPERTENSIVE URGENCY AT EMERGENCY DEPARTMENT ENTRY

Abstract

Introduction and Aims: It is controversial whether the patients with hypertensive urgency (HU) without target organ damage need rapid reduction of blood pressure (BP) by antihypertensive medication although the immediate reduction of BP by antihypertensive medication is essential in the patient with hypertensive emergency with target organ damage. Methods: This was a prospective, randomized controlled trial in a single center. We recruited subjects with HU at emergency department entry. HU was defined to be systolic blood pressure (SBP) > 180 mmHg, and/or diastolic blood pressure (DBP) > 110 mmHg in consecutive measurements. Subjects were excluded if they had recent history of surgery, acute trauma, pulmonary edema, confusion, and if they were suspected to have acute coronary syndrome, aortic dissection and neurologic defect. Subjects were randomly assigned to take a rest (n=65) or take a telmisartan (40mg tablet, orally; n=65). Repeated measurements of BPs were done every 30 minute for two hours. Results: One hundred thirty (106 males) participants (mean age, 71.7 years) were randomly assigned to one of two groups. Mean SBP and DBP, and MBP at baseline were 181.4, 102.9, and 129.1 mmHg respectively. Putative causes of hypertensive urgency were omitting BP medication (50%), pain (34.6%) and hypoxia (2.3%). Systolic and diastolic BP decreased significantly up to initial 60 minutes (all p<0.001) and then the degree of reduction of BPs were decreased (all p>0.05). Antihypertensive medication group did not show significant reduction in SBP (F=2.153, p=0.078), DBP (F=1.11, p=0.355), and MBP (F=2.185, p=0.074) compared to rest group in repeated measures analysis of variances. Conclusions: As early treatment for patients with hypertensive urgency, having the patient taking a rest can be equally effective in lowering BP as the antihypertensive medication and it can be as effective and safe as the medication. (Table presented).