Clinical trial NCT06635616: Hypertension Management in Terms of Routine Agents
Official title: Emergency Department Hypertension Management: Effects of Routine Oral Antihypertensive Agents on Emergency Management of Hypertension
Study type: OBSERVATIONAL
Overall status: NOT_YET_RECRUITING
Conditions: Hypertension
Emergency Medicine
Keywords: hypertension
emergency medicine
oral antihypertensive agents
Lead sponsor: Saglik Bilimleri Universitesi
Sponsor class: OTHER
Collaborators: name: Etimesgut Military Hospital
First posted: 2024-10-10
Enrollment: 350
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: patients with known hypertension admitted to emergency department with elevated blood pressure

Brief summary: known hypertensive patients admitted to emergency department with increased blood pressure will be evaluated in terms of antihypertensive agents given at hospital, degree of blood pressure decrease, hospital stay and laboratory and imaging tests ordered. The impact of routine oral antihypertensive agents used by the patients on these parameter will be assessed.

Detailed description: Hypertensive patients account for approximately 1-25% of annual emergency department visits . While this figure varies by region, hypertensive patients are among the groups that contribute significantly to emergency department crowding and workload . Hypertensive emergencies constitute about 0.3-0.9% of all patients, and this number is rapidly increasing each year .

The 2017 AHA hypertension guidelines emphasize that severe elevations in blood pressure (hypertensive crisis and hypertensive urgency) do not require emergency department visits or referrals unless there is end-organ damage . It is noted that treatment in these patients typically involves dose adjustment or a change in medication .

The 2023 ESC hypertension guidelines recommend that in patients presenting to the emergency department with a hypertensive crisis, blood pressure should be gradually lowered with oral agents over a 24-48 hour period. These patients do not usually require hospital admission but can be monitored in an outpatient setting for clinical evaluation. It is noted that their blood pressure may remain elevated upon discharge from the emergency department, and follow-up in a clinic is necessary for reevaluation of chronic therapy .

Some studies have indicated that both oral and intravenous treatments are preferred for patients presenting with hypertensive crises, highlighting that the approach can vary from physician to physician .

When evaluating literature reviews, published guidelines, and conducted studies, it is observed that there are differences between European and American approaches in defining and treating hypertensive crisis, as well as variability in physician management of these patients .

In our study, we plan to evaluate the effect of emergency department treatment on lowering blood pressure in known hypertensive patients (≥140/80) without end-organ damage. Additionally, we aim to assess the impact of the antihypertensive agents that patients routinely use on their length of stay in the emergency department, as well as the frequency and effectiveness of the medications used, and the target blood pressure values achieved post-treatment according to guidelines.

Eligibility criteria: Inclusion Criteria:

1. Patients aged 18 and older.
2. Blood pressure measured at ≥140/80.
3. Diagnosis of essential hypertension.

Exclusion Criteria:

1. Pregnant patients.
2. Individuals without a prior diagnosis of hypertension.
3. Patients with end-organ damage (hypertensive emergency).
4. Patients whose routine antihypertensive agents are unavailable.
5. Patients who leave the clinic without permission, making follow-up data inaccessible.

Primary outcomes:
measure: routine use of oral antihypertensive agents and its effects on emergency service care
timeFrame: from enrollment to the end of follow up duration of 7 days
Secondary outcomes:
Other outcomes:
Locations:
city: Ankara
country: Turkey
facility: Etlik City Hospital
city: Ankara
country: Turkey
facility: Etimesgut Military Hospital
Study officials:
affiliation: Etimesgut Military Hospital
name: Elif HAMZACEBIOGLU KAYISOGLU, Specialist
role: STUDY_DIRECTOR
affiliation: Ankara Etlik City Hospital
name: Gulsen AKCAY, Ass. Prof.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Salvetti M, Paini A, Colonetti E, Tarozzi L, Bertacchini F, Aggiusti C, Stassaldi D, Rosei CA, Rosei EA, Muiesan ML. Hypertensive emergencies and urgencies: a single-centre experience in Northern Italy 2008-2015. J Hypertens. 2020 Jan;38(1):52-58. doi: 10.1097/HJH.0000000000002213.
citation: Nowicki J, Silka W, Zalustowicz A, Rajzer M, Olszanecka A. Uncontrolled hypertension and hypertensive urgency: One-year single-center emergency department experience. Kardiol Pol. 2024;82(4):407-415. doi: 10.33963/v.phj.100025. Epub 2024 Apr 12.
citation: Astarita A, Covella M, Vallelonga F, Cesareo M, Totaro S, Ventre L, Apra F, Veglio F, Milan A. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. J Hypertens. 2020 Jul;38(7):1203-1210. doi: 10.1097/HJH.0000000000002372.