Abstract P359: Resident Management Of Hypertensive Urgency

Objective: Hypertensive urgency is generally defined as a severely elevated blood pressure without evidence of end-organ damage. Consensus statements do not recommend the acute lowering of blood pressure nor referral to the emergency room. Rapid lowering of blood pressure in patients who are chronically hypertensive carries the risk of hypoperfusion and therefore ischemia to vital organs. The objective of this study was to assess residents’ perception of the management of hypertensive urgency. Methods: An anonymous survey was sent via email to all active resident physicians of an academic internal medicine residency program. It comprised of 8 questions regarding the outpatient and inpatient treatment of hypertensive urgency. Results: A total of 47 residents responded to the survey. Most respondents (44 of 47) knew that evaluating for reversible causes of elevated blood pressure is the first step of management. Fewer residents (37 of 47) said the next course of action would be to up-titrate the oral blood pressure regimen. When asked about real life practice, 35 of 47 attested to conservative management with 12 of 47 respondents regularly using IV antihypertensives to treat hypertensive urgency. The most common contributing reason (25 of 47) to pushing IV antihypertensives was pressure from colleagues and staff, with only 2 residents denying ever administering IV antihypertensives. Residents were also aggressive in the management of hypertensive urgency in the outpatient setting with 15 of 47 respondents reporting most commonly referring patients to the ER for blood pressure lowering (31.91%) and 5 of 47 reporting administering clonidine in the office for quick blood pressure lowering. Conclusion: Resident physicians in our program should be less aggressive in treating hypertensive urgency, especially in the outpatient setting. We suspect that the notion that hypertensive urgency warrants immediate blood pressure lowering is prevalent as pressure from staff/colleagues was the largest cited reason to giving IV antihypertensives in urgency. Further efforts should be pursued to educate residents about the current guidelines regarding hypertensive urgency.