{'fraction_non_alphanumeric': 0.03649167733674776, 'fraction_numerical': 0.03201024327784891, 'mean_word_length': 4.94106463878327, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
53 Hypertension in the acute medical assessment unit in St. Luke’s general hospital kilkenny – are we adhering to guidelines?

Background Hypertension is a common reason for GP referral to the Acute Medical Assessment Unit (AMAU) in St. Luke’s Hospital, Kilkenny (SLK). Hypertensive emergency requires urgent and aggressive blood pressure control to limit end-organ damage. Management of hypertension has been proven to reduce the incidence of cardiac events, cardiovascular death and stroke. The aims of this audit were: 1. To ascertain what percentage of patients referred with hypertension were diagnosed with hypertensive emergency. 2. To review whether or not patients referred with hypertension had had appropriate work up (with electrocardiogram and urine dipstick.) 3. To review what percentage of patients deemed not to have hypertensive emergency received unindicated stat doses of antihypertensives. 4. To assess what percentage of patients were managed in compliance with the ESC-ESH Hypertension Guidelines 2018 on discharge. Methods We carried out a retrospective review of the case notes and discharge letters of 106 patients who were referred to the AMAU by GPs with hypertension between January 2019 and January 2020. Results 91 patients were included in the study. 35 (38%) were male and 56 (62%) were female. The median age of patients was 60. 2 patients (2.2%) were diagnosed with hypertensive emergency. Both were managed with oral antihypertensives. 83 patients (91%) were asked about symptoms of hypertension, 86 patients (95%) had an ECG. Only 26 (29%) had a urine dipstick. Of the 89 patients deemed not to have hypertensive emergency, 43 (48%) received a stat dose of an oral antihypertensive. 11 patients (12%) had their stage of hypertension documented. Of these, 8 (73%) were discharged on an appropriate antihypertensives. 24 patients (27%) had stage 1 hypertension, 27 (30%) had stage 2 and 38 (43%) had stage 3. On discharge, 40 patients (45%) were discharged on dual/triple antihypertensive regimens (in accordance with ESC-ESH guidelines.) Of the 89 patients discharged from the AMAU, 69 (78%) were booked for a 24 hour ABPM and 26 (29%) were referred for TTE. Conclusion This audit highlights numerous areas for improvement in the management of patients presenting to the AMAU in SLK with hypertension. It revealed that almost half of patients deemed to have no evidence of malignant hypertension/end-organ damage requiring immediate blood pressure control received at least one stat dose of an anti-hypertensive. The staging and management of hypertension remains a confusing area for some NCHDs, evidenced by the fact that only 12% of patients had their hypertension staged during their review. Positively, almost 80% of patients who presented to the AMAU with hypertension were booked for an outpatient 24 hour ABPM, however only 29% were booked for a TTE. We aim to develop a proforma for managing patients presenting with hypertension and re-educate our staff on the investigation and management of hypertensive patients in order to closer align our practices with ESC-ESH guidelines.