Emergency department visits for high blood pressure jumped 25 percent in just five years, according to a recent study by the American Heart Association. Although more patients came to the ED presenting hypertension during those years, the percentage of admissions and hospital deaths decreased.

"This shows we are not doing a good job in controlling high blood pressure in the outpatient setting. We need better high blood pressure care in this setting," said the study's lead researcher Sourabh Aggarwal, M.D., the chief resident in the Department of Internal Medicine at Western Michigan University School of Medicine.

The researchers collected data on nearly 4 million emergency department visits from 2006-11 in which hypertension was the first listed diagnosis. The study results, presented at the American Heart Association's High Blood Pressure Research Scientific Sessions 2014, show that ED visits for essential hypertension increased by 25 percent. Admissions for these patients fell by 15 percent during that period.

The scientists found similar results regarding ED visits for patients suffering hypertension with complication and secondary hypertension — ED visits rose by 19 percent between while the admission rate declined by 12 percent. On a positive note, the research also reveals that fewer patients admitted for hypertension are dying in the hospital — that number fell 36 percent during the five-year study period.

The researchers say the decline in admissions and hospital deaths may be because ED physicians and staff are becoming more skilled at treating hypertension, but that the increase of ED visits for hypertension shows that patients need more help controlling blood pressure outside of the hospital setting.

According to CDC statistics, 31 percent of Americans have hypertension, and less than half have their blood pressure under control. About 7 of 10 people having a first myocardial infarction have high blood pressure, as do about 8 out of 10 people having their first CVA.

Hypertension causes about a thousand deaths each day in the United States. Hypertension is also a major risk factor for chronic heart failure and kidney disease. The American Heart Association encourages consumers to seek emergency care for hypertensive crisis for systolic BP readings of 180mm HG or more and diastolic pressure of at least 110 mm HG.

The authors of the study did not mention what had brought the patients to the emergency department, but many hypertensive patients do not realize they have high blood pressure — symptoms such as headache and dizziness drive many to seek care. Others realize they have the condition but are unable to keep blood pressure readings under control.

Upon presentation, ED physicians should lower BP aggressively to avoid neurologic end-organ damage, such as hypertensive encephalopathy, cerebral vascular accident or cerebral infarction, subarachnoid hemorrhage, or intracranial hemorrhage. After physical exam to assess end-organ dysfunction, ED physicians should order labs to check electrolytes, BUN and creatinine, and a dipstick urine test for hematuria or proteinuria. Chest radiography and ECG may be indicated for patients with chest pain or evidence of pulmonary edema.

Optimal pharmacotherapy depends on the organ at risk during the hypertensive emergency. Treatment usually includes some combination of sodium nitroprusside, alpha- and beta-blockers such as labetalol and fenoldopam, and calcium channel blockers such as clevidipine.

Once stabilized, the patient may be admitted to the hospital or released to the care of a physician.