Hypertensive Urgency: Teaching Improved Care for an Acute Form of High Blood Pressure

Nearly half of all adults in the United States are living with hypertension, or blood pressure above 130/80 mmHg. Despite its prevalence, managing high blood pressure remains a major challenge in healthcare settings.

Hypertension management can be challenging for a number of reasons, explains Benjamin Gallagher, MD, a hypertension specialist and assistant professor of medicine at Yale School of Medicine (YSM). Aside from difficulties patients may have sticking to their recommended medication regimens, clinicians may also face knowledge gaps regarding complicated hypertension cases.

For these reasons, Gallagher and his colleagues have been working over the past two years to address this issue by developing a specialized medical curriculum for internal medicine residents at YSM. The curriculum covers advanced topics in hypertension management, including hypertensive urgency, a condition marked by blood pressure over 180/110 mmHg but without damage to vital organs.

Recently, Gallagher, along with Donna Windish, MD, MPH, professor of medicine (general medicine) at YSM, and Natasha Cigarroa, MD, hospital resident at Yale New Haven Hospital, tested how the curriculum impacted residents’ treatment of hypertensive urgency in the outpatient setting. The results were published in the Journal of General Internal Medicine on Dec. 11.

The study involved 104 residents who see patients at the New Haven Primary Care Consortium. While all residents received background training on hypertension, only some of them received the hypertensive urgency curriculum, which involved a half-day workshop with lectures and educational materials. Gallagher and his colleagues then compared residents’ notes from appointments with patients diagnosed with hypertensive urgency and measured the frequency of appropriate clinical actions taken by residents from each group. The research team found that the curriculum had a positive impact on residents’ performance: those who received the new curriculum were more likely to increase their patients’ blood pressure medications and/or counsel their patients on medication adherence.

“We were able to show a small but meaningful change in clinicians’ behavior as a result of an educational intervention,” Gallagher says. “At least for a brief period of time after residents received this curriculum on hypertensive urgency, there was an uptick in appropriate management of that condition.”

Given the high incidence of hypertension and how difficult it is to manage, the curriculum could be a helpful tool not only for residents, but also for highly experienced clinicians, including those who might already feel confident in their hypertension management skills, Gallagher says. In fact, a version of the curriculum is available online through the Society of General Internal Medicine’s learning portal, GIMlearn.

There were some challenges associated with introducing the specialized curriculum, Gallagher notes. “How do you convince people that they need to learn more about something that they think they already know how to do well—and do that without antagonizing or belittling them and making them feel like they are inexperienced?” Gallagher adds. “A lot of the aspects of the curriculum were about protocolized care, using easy-to-follow protocols and couching it in a way of trying to make things easier for clinicians.”