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J Korean Soc Emerg Med > Volume 33(5); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(5): 471-479.
Is the immediate blood pressure control using parenteral antihypertensive drug needed for patients with severe high blood pressure with epistaxis in the emergency department?
Kyunghoon Shin1, Kyunghoon Park1, Heekyung Lee1 , Changsun Kim1 , Laurie Seiwon Kim2, Ji Won Yoo3
1Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
2Department of Biology Science, The University of Nevada, Las Vegas, NV, USA
3School of Medicine, The University of Nevada, Las Vegas, NV, USA
Correspondence  Changsun Kim ,Tel: 031-560-2057, Fax: 031-560-2059, Email: flyes98@naver.com,
Received: September 30, 2021; Revised: October 22, 2021   Accepted: October 28, 2021.  Published online: October 31, 2022.
ABSTRACT
Objective:
This study aimed to assess whether the conventional treatments administered in the emergency department (ED) for hypertensive urgencies (observed or peroral [PO]-controlled) in severe high blood pressure (BP) patients with epistaxis increase the incidence of epistaxis recurrence and the mortality rate as compared to immediate BP control using intravenous (IV) antihypertensive medication
Method:
A retrospective study over 7 years was conducted at the ED of a tertiary university hospital. Among adult patients with spontaneous epistaxis, subjects with severe high BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) were included in the study. Participants were divided into three groups determined by the methods used to control BP: non-controlled, PO-controlled, and IV-controlled groups. The incidence of epistaxis recurrence and mortality rate within 6 months were compared.
Results:
Among the 380 patients enrolled, 238 were discharged from the ED without any pharmacological antihypertensive treatment (non-controlled group), 83 received PO antihypertensive medication (PO-controlled group), and 59 received IV antihypertensive medication (IV-controlled group). Of these, 29 (12.2%), nine (10.8%), and seven (11.9%) patients from the non-controlled, PO-controlled, and IV-controlled groups, respectively, experienced epistaxis recurrence within 24 hours, which was statistically not different among the three groups (P=0.948). The 6-month mortality rates were determined to be 0.8%, 2.4%, and 3.4% in the non-controlled, PO-controlled, and IV-controlled groups, respectively. The difference was also not significant among the groups (P=0.294).
Conclusion:
The conventional treatments of hypertensive urgencies (observed or PO-controlled) in patients with severe high BP with epistaxis in the ED did not increase the incidence of epistaxis recurrence and short-term mortality rate when compared to immediate BP control using IV antihypertensive medication.
Key words: Epistaxis; Severe high blood pressure; Hypertensive crisis
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