Comment on It's not that bad quit whining
Zorcron@lemmy.zip 5 days agoHigh blood pressure alone is not an emergency. Definitely something to be concerned about preventing/treating in the long term, but no blood pressure number alone warrants an ambulance without also having symptoms of something like a heart attack or stroke that indicates organ damage.
That said, that kind of blasé approach to markedly elevated blood pressure with no real plan to reassess or find a root cause is still unacceptable, especially lazily blaming it on menstruation like is so common. So not trying to undermine your experience, I just had to chime in bc the “hypertensive crisis” thing is a pet peeve of mine.
but no blood pressure number alone warrants an ambulance without also having symptoms of something like a heart attack or stroke that indicates organ damage.
Idk, I’d say a blood pressure of 300/200 or 50/20 would warrant an ER ambulance trip, even without symptoms
I guess we could argue at what point it is no longer physically possible to be asymptomatic with an extremely high blood pressure, but to date there is no evidence to support the treatment of the blood pressure number alone in the acute setting.
Low blood pressure is a separate issue, but also only really treated if causing issues for a patient; however similarly, one questions the plausibility that a patient could be properly perfusing their organs and therefore have no other signs/symptoms of organ damage with a mean arterial pressure of ~30 mm Hg.
I think once I got near that level post dialysis and had no symptoms…
Until the moment I stood up. Then it was all the symptoms.
Likewise, I haven’t have 300/200, but did have 200+/150+, and didn’t have symptoms… Until I went to try to sleep for the night.
That’s the issue with your premise. It’s reactionary treatment rather than preventative, and from personal experience preventative is much more pleasant.
But I suppose in the USA the standard for example is reactionary treatment due to healthcare only being private and the insurance companies not wanting to pay up.
I know it feels wrong, but the data supports outpatient management of asymptomatic high blood pressure.
And the European Society of Cardiology agrees with the AHA, so it’s not just an American thing. Check out section 10, or ctrl+F “hypertensive urgency”.
50/20 is just about my normal resting.
Every lady’s experience in a red state. Seriously, I’m not making a joke, being a “conservative” as defined in the US political system NEEDS to be categorized as a mental disorder that precludes people from being doctors at the least.
There are so many misogynists in the center (we don’t have a real left) that the orange idiot beat two women.
I mean, beating Hillary was semi-predictable given all her baggage, but beating Harris was … quite a sad display of how shitty the US is.
Apytele@sh.itjust.works 5 days ago
Yeah this very much depends on the actual specific number. I work inpatient so I don’t blink at 155 systolic because we’re gonna take it again in 12h and honestly these days the hospitalist says current evidence supports not even treating emergently until 170. 140s to me is a GP/PCP’s problem 3 months from now and 130s they’ll probably just tell the person to eat less salt. There’s also the possibility that the doctor just figured she wouldn’t take anything anyway based on this person’s description.
Zorcron@lemmy.zip 5 days ago
No seriously, there is no number that you treat emergently without accompanying signs of end-organ damage. The AHA recommends considering “permissive hypertension” even for SBPs over 180. So you could be 220/180 and if no other symptoms or signs of organ damage, you get treated the same as someone who is 145/95, and even then that’s only if the hypertension is chronic. The only difference is it will probably take a lot more meds to chronically control someone whose bp is that extreme.
AHA’s 2024 review article for reference
BarrelAgedBoredom@lemmy.zip 5 days ago
Zorcron@lemmy.zip 5 days ago
Yeah >180 is definitely serious, I may have overstated myself there trying to make my point. If you read that high, it’s recommended to contact your doctor asap, but not to seek emergency treatment unless you’re having symptoms.
Current (but limited) evidence actually suggests some harm caused by unnecessarily treating asymptomatic markedly elevated blood pressure, and low risk of acute (hours to days) adverse events caused directly by the hypertension.
I’m a PharmD who works in the ED at a large teaching hospital. I have this conversation often.
Recommendations from the AHA directly to patients/lay persons
A great “Things We Do For No Reason” article about the topic. (There’s even one article in this paper that specifically talks about patients with systolic >220, only 0.2% of which had a negative vascular outcome at 7 days without inpatient treatment.) I highly recommend this paper. The folks at SHM/JHM do great work with this series.