Big Arse Blood Pressure. Or, how I learned to stop worrying and love the home BP machine.

Here’s a lovely bit of blogging serendipity.  I worked the other night on the road on overtime.  Whilst I was out and about saving lives (mostly my own by parking up at my favourite night shift coffee shop) I got called to assist a crew with a patient who had a scary BP.  Now, she had some other things going on, like a 2:1 AV block, but ultimately she was essentially asymptomatic.  This got the cogs whirring and I thought I should write a post about high BP.

Hypertensive patients are something we see many, many times a week.  Sometimes there are other things going on; usually it is because they have a home BP machine.  So they had a cold, a sniffle, a sore knee, an earache, it was Tuesday, whatever the reason, they decide to take their BP.  They see a number.  Whatever that number may be, they start to worry.  So they take it again.  They see another number, probably higher than the first number.  Panic sets in.  Another BP is taken, the number is higher again: clearly death is imminent, the reaper can be heard whetting his scythe, choirs of angels limber up their vocal cords to sing the poor soul home to the good lord’s arms… you get the picture.

Fortunately I don’t have to write a post about it, because someone has just done it for me, over here at The Short Coat (they have a much cooler title than mine too).

I’ll quickly summarise the main points.  We have two types of hypertensive patients:  The true hypertensive emergencies, such as

  • Acute pulmonary oedema (remember this?)
  • Aortic dissection
  • Pre-eclampsia
  • Subarachnoid haemorrhage.
  • Acute Kidney Injury (maybe)
  • Hypertensive encephalopathy.

Then we have hypertensive… other.  These patients have what ZDogg MD calls ‘high ass blood pressures’ or are ‘fucking hypertensive’  This doesn’t mean we need to do anything about it in the ambulance.  Even if the patient has a headache, it’s more likely that the headache caused the hypertension rather than the other way round (patients with hypertensive encephalopathy may have a headache, but they are also very ill)

The same goes for epistaxis.  It is a truth widely held in paramedic circles that the nose bleed is some kind of escape valve; natures own blood letting for hypertension.  Sadly this is not true, the nose is not the pressure relief valve of the brain.  (On a semi-related note, don’t go sticking gauze pads soaked with 1:1000 adrenaline up the nose to stop it.  Just don’t)

So go read The Short Coat about hypertension, and/or check out ZDogg and Rob Orman’s podcast, or Reuben Strayer’s post over at EMupdate.

The advice for physicians (broadly speaking) is that if you feel you have to treat the hypertension, do so carefully and slowly.

My advice for the paramedic would be: “If you feel you have to treat the hypertension, don’t”  My other advice would be to follow Reuben’s words and remind the hapless punter that home BP machines cause cancer…

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