Blood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care

Abstract

Prehospital hypertensive emergencies and urgencies are common, but evidence is lacking. Telemedically supported hypertensive emergencies and urgencies were prospectively collected (April 2014-March 2015) and compared retrospectively with a historical control group of on-scene physician care in the emergency medical service of Aachen, Germany. Blood pressure management and guideline adherence were evaluated. Telemedical (n=159) vs conventional (n=172) cases: blood pressure reductions of 35±24 mm Hg vs 44±23 mm Hg revealed a group effect adjusted for baseline differences (P=.0006). Blood pressure management in categories: no reduction 6 vs 0 (P=.0121); reduction ≤25% (recommended range) 113 vs 110 patients (P=.2356); reduction >25% to 30% 13 vs 29 (0.020); reduction >30% 12 vs 16 patients (P=.5608). The telemedical approach led to less pronounced blood pressure reductions and a tendency to improved guideline adherence. Telemedically guided antihypertensive care may be an alternative to conventional care especially for potentially underserved areas.

Keywords: guideline adherence; hypertensive emergency; hypertensive urgency; telemedicine; treatment and diagnostic guidelines.

Conflict of interest statement

The authors report no specific funding in relation to this research. JCB and RR are shareholders in Docs in Clouds, Aachen, Germany (telemedical service and consulting). All other authors declare no conflicts of interest.

©2017 Wiley Periodicals, Inc.

Figures

Figure 1

Standard operating procedure (SOP) during the study phase (translated version, original version in German). EMS indicates emergency medical service; NIBP, noninvasive blood pressure

Figure 2

Standard operating procedure (SOP) during the historical control phase (translated version, original version in German). No telemedicine system was available. EMS indicates emergency medical service; NIBP, noninvasive blood pressure